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.