June 24, 2012

I had a three-day work week (two in, one out) lined up, but one of the nurses that I usually cover for in eating disorders needed my help, and I couldn't say no.  So now I have a four-day work week (two in, two out) liked up.  No regrets though:  unless there's an unforeseen crisis, it should be a smooth day and I'll be out by 1500 the latest.  And four days is all it will stay:  I'm keeping Monday free to relax, do some school work, and catch up on my knitting.  The blanket for my nephew is long-overdue.

The ear infection has improved.  The pain has decreased considerably and it's still draining.  Now I wish full hearing would return to the ear...if I did rupture something, I wonder how long that takes to heal.

The pregnancy goes uneventfully:  it's been pretty asymptomatic once the dizziness resolved.  The nausea ended with the dizziness, and I've had no other issues.  I'm grateful yet disconcerted.  Both my prior pregnancies had minimal discomforts early on, so this is normal for me.  Still, I occasionally wonder if all is well in there (my average is .500).  My first appointment with ultrasound is on the 11th, so I guess I'll know then.  Until then, I'll work on the premise that no news (or symptoms) is good news.

June 22, 2012

So that dizziness might have been an ear infection in the making.

The dizziness stopped a few days ago, to be replaced by a clogged ear.  The pressure in the ear--as well as fluid being trapped in it--kept increasing until the other day, when the pain hit.  So I called my doctor.  He's out of town, but the doctor on call phoned in an antibiotic for me...which was quite the challenge for him to pick out, given that I'm both pregnant and allergic to penicillin and sulfa.  But one was found and I started it along with Tylenol.

I'm not sure, but I think my ear is draining...or the trapped fluid/water is escaping.  Still hurts like hell though.  I hope nothing ruptured.

I had to work two days with the pain, so I decided to take Monday off and treat myself to a three-day weekend of rest...well, as much rest as I can get given I have three tests, one discussion question and two discussion responses to post.  I'm nowhere near ready for any of it...I'm trying to accept the fact that this is the week I'm going to tank on everything, and that I'll have to make it up over the rest of the course.

My mini-vacation from inpatient work was nice.  My work was missed by some of the staff, which is always a bit of a compliment.

When I returned, they put me in the psych ER but let me play with the LVNs in the back...so my day, while hectic, was much better compared to the day the nurses were having in triage.  One patient was manic (I always get the manics...) and we kept having to redirect her to remain dressed.  The sad part is that the meds didn't touch her...she finally paced herself into exhaustion.  The other was mute and very disorganized...he took direction well and was cooperative, but didn't talk.  He also radiated tension like a bomb about to go off, so I pretty much did what I had to do and let him be.

Meanwhile, the acuity in outpatient seems to have leaped drastically.  I admitted a few patients whose psych (non-CD) issues were greater than their CD issues...and I don't just mean depression, anxiety or borderline personality disorder:  I'm talking about paranoid schizophrenia, schizoaffective and thought disorders.  So I needed to take quite the different tack during my assessments...how one talks to a high-functioning dual patient is rather different than one who is lower functioning and somewhat psychotic.  But the admissions went well.

June 20, 2012


My school's Blackboard server is going down at 1800 on Friday.  This means that I don't have until my usual 2100 to get work in...and since I'm working on Friday, I pretty much have to do it all by Thursday.  So I rearranged my schedule, including taking a day off from work this week, in order to get my assignments done on time.

I get a message from one of my instructors:  because of the outage, the deadline for the Friday assignments have been moved to Saturday.  As the other class requires assignments due at 1500, I don't expect any extension from them.

I should be happy, right?  Actually, I'm rather miffed.  Irrational, I know...but I am.

I'm still going to try to wrap all up I can by Thursday, so I can have the weekend to study for the three tests that I need to take on Sunday.

I don't regret the day off though.  I did get a lot of schoolwork done, and the little one and I were able to enjoy a lunch date.  I felt bad about calling out at the agency though, until I remember that this was the exact reason why I work at the agency:  so I can dictate my schedule.

June 17, 2012

Happy Father's Day

Happy Father's Day to all the dads out there...if you consider yourself a father in any way, shape or form, this day is for you!

Hindsight being 20/20, I suppose I could have waited the few days to tell the other half about the pregnancy, and did it today in some cutesy way...but I guess I was too stunned to think that one through.  And to be honest, historically the other half isn't good about picking up on clues on these things.  I told him about the first pregnancy by ordering him a Dallas Cowboys onesie.  He thought it was for the cat...I kid you not.  So for the second pregnancy I made it very clear to him by giving him a book called, "What to Expect When Your Wife is Expanding."  He got the message faster this time but it did require a little explaining.   I figured this time, it'd be safest if I just told him outright.

Trying to get my Texas History test wrapped up early today so I can relax.  This is going to be a really rough week since there's only one week until the second Texas test, plus I have discussion questions, discussion question responses and project feedback due.  AND I have the usual two tests and two learning projects from the politics class.   In addition, the school's servers are going down for maintenance on Friday so I have until 1559 instead of 2159...translation:  since I'm working Friday, it's all due Thursday.

My work schedule has be split between inpatient and outpatient, which is nice since I'll have some breathing room--as well as opportunities to do some studying during the outpatient job when things are slow.

I think I'm getting a little burned out from the inpatient job.  Yesterday was a bad day and I didn't handle it well as I usually do...well, no one could have found fault in my performance (except the disgruntled parties involved but then again, they were biased), but I wasn't happy with it.  I think it's time for some time away from inpatient.  In a happy coincidence, there's been an increased demand for my services in outpatient through mid-July, so I signed on for a lot of days.  So that means only two agency days this week, none next week unless I decide to work on July 4th and/or pick up a day on that weekend, and only two days max the following week.  By then I should be ready to return to the inpatient ring more often.

The flirting nurse--who by the way I learned is married--has ceased flirting.  While I'm mostly relieved, a tiny part of me is also irrationally miffed that apparently I'm "no longer good enough".  Ah, the joys of pregnancy hormones :)

June 15, 2012

It's Giant Brazilian Killer Moths!

The little one is watching Fireman Sam...that's where the subject line came from.

Doctor's appointment went well.  Blood pressure is lower than it usually is (104/76) which is good considering I was prehypertensive for a while.  But according to my PCP, that's probably not what's causing the dizziness:  the pregnancy itself if the culprit.  They don't know why it does it but it does it...and I have to take care of myself and just ride it out.

The politics classes continue on.  I've already had four tests in the US class, with an average of 90.  The first Texas test is Sunday...it's worth 10-12% of the final grade.  I have to work tomorrow so I finished all of the other class' work today, then plan to spend tomorrow evening and all Sunday studying.  Since it's the first test, I have no idea what to expect.

I've also decided that I don't need a 4.0 this time around.  I'm still going to try my best--and at least in this program I only need a 90 for an A--but I've decided that I'll be OK with a couple of Bs here and here.

June 14, 2012

What a day

It was one of those days in the psych ER best described as someone opening the gates of Hell.  High acuity AND volume meant that I had no lunch and I left an hour late.   Met way too many law enforcement officers...and had to explain the rights of psych patients to way too many law enforcement officers.

Everyone was short-tempered, even the nurses' unofficial favorite doctor (reason:  he talks TO patients and staff, not AT them).  Plus the evening shift was short-staffed, so they were asking for volunteers, especially RNs, if they'd do a double.  I declined due to too much homework to do, as well as not having any food on me:  I can't do 16 hours on an empty stomach.

Still, no one died and no codes were called so it was a good day.  We came rather close to having a couple of codes though.

I was dizzy during the early part of the morning, but it resolved by my second patient.  It returned at home.  Nausea went away...though honestly, I think I'd rather have the nausea over the dizziness.

I go to the doctor tomorrow...yeah, I said I'd wait until I was a week late, but thanks to the bureaucracy that is my healthcare insurance, I have to go to my PCP to get referred for OB care, and that process can take forever.  So I figured I'd get it started now.

June 13, 2012

In which Meriwhen kills the rabbit

I was nauseous on Saturday morning:  I chalked it up to eating cereal instead of my usual egg sandwich for breakfast.  I was nauseous on Sunday morning; I chalked it up to being up until 0300.  I was nauseous on Monday morning; I chalked it up to the drive to work (I have a bad history of motion sickness).  I was nauseous yesterday morning; I chalked it up to the car drive again...until I realized that the reason I always choose to drive in the car is that it's the only way I avoid being carsick.

Two prior pregnancies (one kid, one loss), and I never had morning sickness before...well, I had it for all of 8 hours one day in the first trimester:  the rest of the little one's pregnancy was a non-stop cheese binge.  So now I'm wondering.

Got through work.  Got nauseous several times at work; I chalked it up to dealing with some pretty funky patients and their urine.  It didn't help that this week's theme seems to be "need to shower the patients."

Got flirted with by one patient and three (!) doctors.  Patient was manic so I wasn't too surprised.  The other three, I was mostly surprised.  Began to wonder if I'm radiating something, especially since I told one doctor to go away because he was bugging me, and the other that the next time I see his manic patient (said flirting patient), I'm making him come along so he can get to see the sights I had to see when I did his safety search.  Didn't put any of them off.  And no, the other doctor who told me all the details about his dating difficulties wasn't one of them.

Got home.  Had cheese and cookies to quell the nausea.  Didn't work.  Had dinner.  Didn't work.  Decided I may want to try that pregnancy test that I have.  Requiem for a Rabbit.

Well we were kind of trying...still, I'm rather stunned.   Good stun though.

I told the other half, and he's happy.  He also told me I can quit working tomorrow, at least quit the agency job.  I told him that my sitting at home for 9 months will not do me any favors, but that I will follow whatever advice my doctor gives me and scale back as I go along.  I reassured him that psych nursing isn't really as bad as it is shown to be in the movies...and that if they knew I was pregnant, they would not make me go to the really dangerous codes.

And based on past history, I'm not quitting work until my health or labor makes me.

Slept late today (outpatient today).  Homework this morning.  Dizziness when I shift positions.  I'm also trying not to throw up on the keyboard.

We didn't tell the little one yet.  Nor are we planning to tell him, or the family--or anyone really, for that matter--until the end of the first trimester.  Reason 1:  I miscarried before.  Reason 2:  it's going to be a high-risk pregnancy so let's just get past week 13 first.  Reason 3:  because of our ages, we're going to have CVS done and should (God forbid) there turn out to be problems, we don't want to have to explain or justify anything to anyone.   Heck, no one knew we were even trying!

OK, y'all know.  Need to be able to talk about it somewhere.  I don't do pregnancy boards because I find they go to ridiculous extremes about their pregnancy...must be the hormones in the posters.

Next week I'm going to make the appointment to see the doctor...figured that I should wait until I'm officially a week late before I do that.  I know a lot of pregnancies end before they're even known--the period comes on time or a little late.  I happened to have a really good pregnancy test on hand so I got to know 3 days early.  But I know there's a good chance this could end...so we just have to wait and see.

Going to (attempt to) do some politics homework.

June 10, 2012


Zydis (Olanzapine/Zyprexa) has to be the greatest medication on the face of this earth...followed closely by the Risperdal M-Tab.

That's all I have to say for today.

June 9, 2012

HIPAA: a love/hate relationship

I have discovered that when it comes to HIPAA (often mistakenly spelled HIPPA, but I know what you mean), there is a love/hate relationship.

Patients love HIPAA:

Them:  "I don't want you to tell my mother anything about my care."
Me:  "OK"
Them:  "Will my job find out I'm here?"
Me:  "Only if you tell them.  By the way, your mom called wanting information.  I told her I can't confirm or deny that you're here, that I could only take a message.  She wasn't happy about it."
Them:  "Thank you!  I hate the bitch."

But when they're the family, friend, or other person trying to find out information about a patient, they hate it:

Them:  "I know my daughter is there, I dropped her off, for God's sake!  Why can't you tell me anything?"
Me:  "I'm sorry, without a release of information I can't discuss her care.  And she has not yet authorized me to talk to you."
Them:  "But I'm her mother!"
Me:  "She is a legally competent adult and the law protects her privacy."


Them:  "They don't know where she is, her family is worried, I know the police dropped her off a month ago, can't you do anything?"
Me:  "We have no patient by that name in our facility at the moment.  You can try calling other facilities or contact Missing Persons."
Them:  "But I know they took her there, the cops told us.  Can't you tell me where they have sent her?  Her kids don't know where she is!"
Me:  "I am not unsympathetic to your concerns, however the law prevents me from telling you if and when she was here and if she was, where she may have been transferred to."
Them:  "You're heartless.  Can't you throw us a bone?"
Me:  "Sorry, but that is the federal law."


Them:  "I don't think she should be released, she's down right crazy!  She did...."
Me:  "When she will be released is up to her and her doctor."
Them:  "Well, I want to talk to her doctor!"
Me:  "I'm sorry, she has not authorized us to allow that."
Them:  "But she's fucking crazy!!!"
Me:  "She is a competent adult, and her and her doctor will work together regarding her treatment."
Them:  "I'll sue you, all of you if she's released!"
Me:  "That is your right.  However I can't let you talk to her doctor without her permission."

This further supports my beliefs that it's not always the psychiatric patients that are difficult and abusive:  it's often their families.

June 8, 2012

The things you learn in psych

I learned that Maslow REALLY does have something behind his theory.  Food is one of the most potent anxiolytics there is:  feed a 5150 who hasn't eaten well for several mealtimes, and you will find they become a lot more cooperative when being admitted.

I've learned it's really easy to tell the difference between someone who is truly paranoid and someone who really isn't.  If you tell me you're paranoid, you may or may not be.  If you keep pointing out every little thing and specifically stating, "I'm paranoid about that," you're probably not.

I learned that all cats have at least one Axis II diagnosis.

I learned that most patients will jump to take any medication if you tell them that it works just like Valium.  Note that I didn't say to tell the patient it's Valium when it's not:  I've never lied to patients about medications and I'm not about to start now.   But telling them that a medication will calm them down like a Valium does is a fair tactic...there's not always a need to immediately tell them that it's Geodon and Benadryl, especially if they're in the midst of psychotic delusions and about to lob a chair at me.

I learned how transgendered patients in prison make cosmetics for themselves.  Seriously.  It's mostly ground-up candy.  M&Ms can go a long way; so does Kool-Aid.

Two more assignments completed, bringing the count to 49.

No work this weekend, even though the agency called to ask if I was free.

I heard a couple of things about the facility I'm at...apparently they are on a hiring tear because they want to cut back on the number of agency people.  Then again, they've been having a hard time keeping any sort of nurses for the last couple of years:  either they've moved on to other things...or here one day, fired the next.  And they always seem to be desperate for nurses to work right now, so I'm not worried about losing hours just yet.

I've still got the outpatient job.  My outpatient hours are starting to pick up as some of the nurses want to go on vacation and I'll be covering for them.  Another nurse is pregnant and has started taking time off, so I'm covering there too.  Also, said nurse will be going on maternity leave soon, and the unit manager pretty much told me I could have all of her hours while she is out.  I would...except that it's mostly evenings.  So I said that I could promise to pick up some for now and we'll go from there.

Also, I found out that my main facility has its own inpatient registry services, so I could always suck it up and apply there.  Actually, I don't know why I haven't done that:  I'd be getting paid quite a bit more than I am now...oh yeah, the whole loss of my scheduling freedom.  If I went registry at my facility, I'd lose a lot of that.

June 7, 2012

Assignments/tasks due for both politics classes:  53 over the next 8 weeks.

Assignments/tasks remaining:  51 (2 completed today).

And I'm only on day 4 of the summer session.

Oh well...at least after this summer session, I won't be taking two non-nursing classes simultaneously ever again.  Though it is a nice change not to have to do nursing-related coursework.

June 6, 2012


So far I learned two things in my Texas Government class.  First, Texas really was once its own country, so the "It's a whole other country" saying has a lot of history behind it.  Second, a Texas Government class has been a government requirement for students in Texas colleges since 1937.

I love listening to the lectures.  The professor's Texan accent is soothing.  The textbook leaves a lot to be desired, though.

My agency called me...they weren't sure if I was working today.  They saw me down for every weekday this week but Wednesday and called me at 0600 to see if it was a mistake that I wasn't down for today...and if it wasn't, did I want to work anyway?  I told them that on Wednesdays I do schoolwork in the AM, and am promised to another job (outpatient) in the PM.   But it's nice to know they care...and that they still have hours to give me.

I'm actually glad for the day off.  The full moon AND lunar eclipse made for a very chaotic ER on Monday.  Codes left and right.   Fists flying as well (none landing on me, thank God).

Yesterday was much more tame but still had its moments.  I was able to work my daily miracle (I tell them at work that I can only work one miracle a day) on a very loud, delusional and uncooperative 5150.  Fifteen minutes of being screamed at and threatened by him while trying to do my triage assessment.  Fifteen more minutes of screaming and threats as I was persuading him to take the medications PO.  Fifteen more minutes later, he was all hearts and flowers.   Zyprexa PO will do that to a person.

The police were impressed.  I like it when I can impress cops, because they've seen it all.  It's a high bar to clear.

Off to Texas (Government) for the morning!

June 3, 2012

Lone Star

Found out that Former RN-BSN program did finally get their CCNE accreditation.  Good for them.

I still feel a twinge because had I not had to move to the West Coast, I would have graduated with my BSN this past month...but I had no choice.  Also, even though Former RN-BSN is now entirely online, they have restrictions on what states they'll accept students from...so basically, if you don't live in Former RN-BSN's state or one of the adjacent ones, they won't take you.  So once I moved out west, there was no way I could have continued the program, even if I had wanted to.

On the brighter side, I am enjoying the Current RN-BSN program more:  despite all of the additional coursework, I feel like I'm getting something out of my nursing education instead of just paying money to go through the motions.  Fluff, this program ain't.

If you haven't figured it out from the last post, I'm in the University of Texas at Arlington.  What other school on this green Earth would make me take a Texas History class for a nursing degree?

Actually, it appears that all colleges/universities in Texas will make you take a Texas History class as part of ANY degree:  I think it's a state requirement.  Texas does claim to be a whole other country...and having once lived there, I have to agree:  it really is.  We may move back there when the other half retires from service.  We loved living there, so it would really depend on what the state has to offer in the world of psychiatric nursing jobs.

June 2, 2012

I'm insane...or a masochist. Probably both.

The two politics classes start on Monday.  I just finished updating my calendar and Remember The Milk with all of my assignment and test due dates.  Both classes are 8 weeks long, so they're not as bad as the 5-week insanity...but they are not as leisurely as the regular 15 week classes.  I guess they're semi-accelerated.

In one corner, we have U.S. Government.  All tests and learning projects.  No papers, presentations or discussions, but two tests and learning modules each week.  And they're not short little quiz tests either...nor are the use of notes allowed during the test.  And I do honor it when an instructor says "no notes" for an online test.   Time assignments are due:  1700 CDT...so for me since I'll be working during all of this, it's actually due the day before.

In the other corner, we have State and Local Government...i.e., Texas 101.  No, I didn't move back to Texas.  Yes, I have to take this class for my BSN.  Fewer tests but more discussions, a presentation and a paper.  Things are due at 2359 CDT, thank God, so I didn't have to play "Adjust the Due Date."  I just have to have it turned in by 2150-ish.

Remind me why I did this again...oh yeah, so I can finally get this BSN done.

So looking at the calendar, I already have assignments due on Thursday and Friday, with my first two tests on Sunday.  I am working Monday through Friday at both jobs.  I guess I should bring the textbook with me for reading during breaks and lunch...and some notepads for taking notes.

I did break my rule about not studying on vacations and read a bit of the U.S. government book before I received both syllabi.  And after reading both syllabi, I think I'm going to have to break that rule again tomorrow and do some serious reading.  In fact, I shouldn't expect to read anything but these two textbooks for the next 8 weeks.

I better enjoy my last night of freedom while I can.

June 1, 2012

The work week is over

Decided to pick up that Thursday at the agency.   I figured I'd get the working in now before classes started up again...plus the extra money will be good.  So yes, I worked 6 straight days between outpatient and agency.

Let's see what happened this week, in no particular order...

I had a rather unpleasant incident with a 5150 involving some juice.  *sigh*  Sad part was that I kind of saw it coming.   The police who were with the 5150 were far more upset about the incident than I was and would not leave me until I had the patient secured.  I can't say I was thrilled with what happened, but I got myself cleaned up, kept calm and carried on.  I also stayed as far away from the patient as I could.  Don't know if it was true psychosis or the patient not liking me, or a combination of both, but I wasn't interested in finding out.

I worked a shift on Stepdown 2.  I learned that there is a difference between Stepdown 1 and Stepdown 2, and that is that Stepdown 2 is technically for the more acute and AWOL-prone patients.  Looking at the layout of the units, I can understand why:  it's a lot more work to escape from Stepdown 2 than Stepdown 1.   Though it seems like the patient acuity is evenly spread across both units.

I'm definitely getting my stepdown legs back, and this shift went a lot better than the last time I was on a stepdown.  Most of my patients were detoxing so that was old hat.  I also had one patient who was paranoid and delusional, and after enduring 5 minutes of interrogation, protests and sarcasm, I had to very pleasantly set limits and end the conversation.  He actually wasn't too bad:  he went through berating the rest of the staff in under an hour, then spent the rest of the shift quietly watching television.

I attracted the attentions of two manic patients who apparently decided that I was a goddess on earth.  They kept staring at me, waving and making comments.  Nothing derogatory, but pretty much as heavy flirting as they could get away with.  I tuned them out as much as I could and went about my business.  Unfortunately, I kept getting them assigned to me because guess who was the only nurse who they would listen to?  Yeah.  But they responded to the limits I set every time.

That male nurse I mentioned in an earlier post continues to flirt with me, but he's pretty harmless.  As long as he stays harmless, I'm chalking him up to just being the flirtatious type.  He told me that he was happy that I had to come over to his unit so he could see me again.  I told him I'm glad he was my sane fan this week, especially after the two manic patient admirers.

And then I think I was actually the recipient of flirting by a doctor.  I was waiting in the doctor's lounge for another doctor to return, and he was sitting there working on his own stuff.  No one said anything for a minute.  Then he asked me how I was doing.

"Not too bad," I reply.  "How about you?"  Pretty standard ritual, no?

His response is to tell me how he just broke up with his girlfriend and how it's been hard for him to date right now.  I learned a lot about him in those few minutes.


I told him that I'm sure he'd find someone who was into him.  Then my own doctor returned and that was the end of that.  And that was pretty much the extent of our interaction all shift.  So this was either his attempt at flirting, or he saw me as someone who he could confide in and who could dispense sage romance advice.  Considering my forays into the dating pool ended many many years ago, I don't know what advice I could have offered him.

The doc is not bad on the eyes...actually, he's really nice on the eyes.  I'm sure he'll rebound and do just fine.

Then there were two shifts in outpatient as backup to the nurse that I usually cover for, which was really nice since I never get to work with her.  But they had a lot of admissions that week and my services were definitely needed.  Challenging, hectic, with Axis II in full bloom...must have been something in the water.  But overall it was fun.

Then another two shifts in outpatient CD.  One was in a backup capacity and was fun.  The other, I was covering for the regular day shift nurse and it was not as much fun.  That was due to the fact that I hadn't worked solo there since my orientation five months ago, so most of my frustration was due to getting used to the routine, the faces, the procedures, etc.  More Axis II but with CD so less frustrating...but man, can the patients be needy.  I couldn't go for five minutes without one coming to ask me something.

So a blissful weekend off before another week of work...and the two politics classes...begin.