Boxing Day

It's rather appropriate that the gift for little one #1 that I ordered from the UK arrived today.  And little one #1 loves it.

The surgery is scheduled for January 8.  The first batch of pre-op work looks good, and they are optimistic about both his prognosis and his survival rate.  He is at higher risk of not making it through surgery due to his age and his cardiac conditions--and of course, no surgery is without risk even for the healthiest specimens--but the odds are still overwhelmingly in favor of him getting through it OK.

I was told NOT to come out for it because I would do no good. Dad is going to be in the hospital for at least 3 days, and I will not be able to go to the hospital with little one #2 in tow.  My parents said they will let me know if they need me, and then I and little one #2 will fly out.  I'm thinking I may be needed afterwards when Dad is at home, but we shall see.

So I'm a little frustrated that I can't be there, but I understand.

Merry Christmas

If you celebrate Christmas, Merry Christmas.  If not, I hope you're having a merry day anyway.

I just finished talking with my parents via Skype.  It was a little hard not having them here, especially given why they couldn't be here.  But at least we could see them, and them us.  My mom said that she had a difficult morning, but she snapped herself out of it to celebrate the day with my dad.  Tomorrow they go to the surgeon to start planning the tumor removal.  I don't know when that will be...they're hoping to do it soon enough so they can be out here for the February birthdays.  

My better half tried getting me something new...jewelry.  He actually did well with two of the three items he picked for me.  He knows I don't wear it often, so subtler pieces are a better choice for me.  One was a blue topaz (my birthstone) earrings and pendant set; the other was a small pendant with my first initial in crystal chips.  The one piece that wasn't subtle...well, he said he thought they'd be perfect stocking stuffers.  And yes, large dangling crystal snowflakes are just that.  I am wearing them right now.

I also got a big haul of yarn, knitting needles and pattern books.  Next year, I'm going to make a Doctor Who scarf.  I'm a classic Who fan:  they kind of lost me after Christopher Eccleston, who was brilliant but didn't want to stay more than a season.

 

All of the boys were excited about their gifts.  Little one #1 was ecstatic opening gifts; little one #2 was ecstatic eating the wrapping paper.  Two gifts didn't make it in in time:  one for the better half, one for little one #1.  The former's gift is backordered; the latter's gift is coming from the UK.  A little disappointing for me, but what can I do?  

Last night, I caught Midnight Mass from the Vatican on the Vatican's website.  I have to admit, Pope Francis is a Pope I can get behind:  he's not all talk and no action.  He lives his word.  He renews my faith in my Catholicism.  And we share a lot of similar points of view...that reminds me, I seriously have to find a Catholic church around here to start going to.  

Anyhow, for today's entertainment, we've been chilling out, watching religious/Christmas/holiday movies.   The last one we just finished was King of Kings.  I think next may be Ben Hur or The Year Without a Santa Claus.

No work until next week.  Whee!

Woo hoo!

The cancer didn't appear to have metastasized.  The PET looked everywhere except the brain and didn't turn up any evidence of growing tumors.  Not sure why they didn't do the brain though, but my sister tells me it's not likely to have spread up there.

So that's pretty great news given that he's still got lung cancer.

They meet with the surgeon on Boxing Day to start pulmonary testing and get the surgery organized.  They're not sure how far the tumor extends down, but going to try to preserve as much lung as possible.  Apparently they can rewire the bronchial tubing if necessary.  Worst case scenario:  the whole lung goes...but that's OK.  Pope Francis only has one lung and look at him:  he's a globe-trotting Pontiff.  He's also the same age as my dad, so even more proof that losing a lung won't be the end of things.

Now I can focus on enjoying the holidays a little bit more.

They are all at the doctors' offices as I type (lab, then pulmonology).   The PET went well yesterday and that's all I know.  Everyone is quietly optimistic.  I'm trying to be as well.

I'm off work today, trying to soothe a cranky little one #2 as I wait...

Update

Got a call from my sister...it is squamous cell.  I guessed right.

Now whether this is the "great" option remains to be seen.

In which Meriwhen learns nothing new

Well, not entirely true.  But it sounded good as a title.

So the first round of pathology results are in...and it's definitely cancer.  However, we don't know what type of cancer it is.  It has been narrowed down to three:  adenocarcinoma, squamous cell carcinoma, and some other type carcinoma.  One of these is really slow to grow and spread and if it were this one, it'd be great.  For the other two, not so great.

We won't know until the next appointment on Thursday.  In the meantime, Dad has a PET scheduled for tomorrow to see if it has metastasized.  My sister couldn't understand how they couldn't tell what type it was right away.  I think they want to wait until the PET is done so they have all the info.

I'm going to guess that this is squamous cell, as that one apparently likes to grow in the bronchial tubes and that's where the mass was found.  But who knows?

No one mentioned if it's possible that this is a cancer from elsewhere that spread to the lung.  I guess if they see metastasis, then that means it's very possible.

If we caught this in the early stage, then the 5-year survival rate is decent.  If it's late stage...

So more hurry up and waiting.

On an up note, apparently Dad is a good cancer for surgery, so it must be located in a better spot than they originally thought.  They're optimistic that they could remove it and preserve the lung.  If they can't, his other lung is functioning well enough that it could do the job alone if it had to.

I took a long walk today to clear my head...and to work on losing the next 10 pounds.  Since all of the parents bailed on coming out to visit, there's no excuse for me to not work on it.  So I walked over to the town line and back.  Well, the second town line I came across because I live right on top of a town line:  I go to the corner and I'm out of town and into in unincorporated space.  So I walked until I reached a line into another town, then walked back.

I was cancelled at one job today.  I had an opportunity to pick up work today but declined.  I did drop little one #2 off in daycare today.  I need today to get some Christmas stuff done.  I also need a day to myself to unwind, relax, and knit my nephew's Christmas gift.

My parents set up Skype so they can see the boys.  I have Skype but I rarely use it.  The only person I've really used it with is my sister.  My in-laws have Skype but I don't use it with them because what they like to do is wait until they have everyone over and then put me and the boys on display, and I don't really like that...especially as they usually catch me by surprise and not warn me that I'll be talking to people that I hardly know.

But now that my parents have it, I can use it for them too.

So yesterday we all video-chatted.  They got to see the boys.  I got to see them.  My dad looks surprisingly good.  My mother, not so much.  But she's bearing the brunt of all the stress so it's understandable.

I learned that it isn't Tuesday for the results to come in, but Thursday.  More waiting.  Whee.

Moving into lighter topics...I've started working at three new programs.  One is pretty intense, with a patient population that is heavily Axis II and SI.  The other two have patient populations that are more laid back but no less acute.  All are very interesting to work, so I'm enjoying myself.  I have an open order--at least for this month--at the intense program to come in whenever I'm free to help them out.  That's the work I could have picked up today, but declined to.  I'll be there on Wednesday, and I told them if the agency cancelled me on Friday I'll be up there.

The intense program has me honing my suicide risk assessment skills to perfection, since I have to perform a thorough one on nearly every patient that walks into the door.   I've also learned some new techniques to improve my psych assessment skills that I've started using in other programs that I work.

The other programs give me more opportunities for patient education.  Most of my education has been about non-psych (i.e., medical) conditions and care.  Comorbidities run amok in chronic psych patients, and a lot of the time the patient themselves either downplays or ignores them.

I've also had some good shot practice as I administered several depot medications.  They asked me if I would be OK in giving the shots.

"It may take a little getting used to," I replied.

"How so?"

"They're cooperative.  I'm used to a bit of a fight."

Haldol dec is a bastard...thick as Ativan, so it's hard to pull AND push.  I feel sorry for anyone that has to give--or get--it more than q2 weeks.

So...

My dad went through the procedure well.  However, it is a tumor.  There's a lot of cells there.  They got the sample and expect the results by Tuesday.  Apparently the surgeon that they had to call in knows what it is but said that we should wait for the diagnosis to be sure.

So yeah, not good.

I'm remarkably OK.  I thought about why I'm containing it so well on the phone or talking about it with  others, but then I realized that I've had four-plus years of practice in containing it well in front of others.  When you hear patients tell you of unspeakable things that they have done or had done to them, learn of delusions too horrific and fantastic that you shudder to think of the possibility of them being real, and--unfortunately--to have to revive patients who have been found cut or hanging in a homemade noose....well yeah, you get good at keeping the reactions in check.

My sister, on the other hand, is a PhD specializing in cancer research.  She lost it.   Repeatedly.

She decided to fly out to NYC to be there for my parents and to make sure, in her own words, "the right questions get asked on Tuesday."  I had to agree:  I may be the nurse, but cancer is her forte.  If anyone knows what to ask about all of this--and isn't afraid to ask it--it's her.   I fear for the doctor that they will see on Tuesday...between my sister and my mother, he will be thoroughly interrogated.

Also, it may be really hard for the parents if we both came out and left right before Christmas.

So she went out first and will be back before Christmas.  If I have to go out, little one #2 and I will go out after the holidays...or sooner if needed, God forbid.   While I don't have a packed bag on standby just quite yet, I've mentally prepared to drop everything and have little one #2 and I on a plane going East within 24 hours' notice.

It's currently snowing in NYC...that hurts too.  Snow in NYC is magical.  Snow in NYC surrounded by family is even more so.  I miss snow.  It's 75 and gorgeous where I currently live, and there's a lot to be said for this weather, but I miss the snowfall.  The world is so silent when it happens.

Anyhow...so it's still the waiting game.  Whee.

My birthday was nice.  I did very little except relax...try to, anyway.

I was going to write about my trial by fire at work today, but my father's procedure is tomorrow and I'm not really in the mood.  I'll have to type it up when it's all over though, because it was entertaining.  Though you'll probably hear about the procedure before my work adventures.

So things are the same

Just finished a long week of work.  I've done enough suicide assessments that I no longer need to read the questions off of the form...and there are a lot of questions.  

Anyhow, the procedure/biopsy is next week so it's all about waiting.  My mother says that my dad is taking all of this very calmly...almost too calmly.  It is the calmness that is unnerving my mother more than anything.  She told me that she's been staying late at work to avoid going home.

Consideing that I found myself booking shifts 6 days in a row to take my own mind off of things, I couldn't throw stones.   My mind wanders down dark roads if I have too much time to think.

The doctor is optimistic given how fast the growth appeared:  he thinks there's a chance it may be a foreign object or cartilage.   Meanwhile, I've done some reading up on bronchial cancer and found that the five-year survival rate is very good.   Of course, as it stands right now, surgery to remove it completely isn't going to be an option, so whatever they can't remove during the procedure will have to be treated with radiation or chemo. 

Maybe one good thing will come of this:  perhaps it will finally scare my parents into finally quitting the cigarette habit.

I did go back and unschedule myself on my birthday.  

In which Meriwhen is socked in the stomach

Not literally, though given the specialty of nursing that I work in, I'm sure a few of you were thinking that...

My mother called to tell me that they had to cancel their trip out here for the holidays.  The sock in the stomach is the reason why it was cancelled:  they found a growth in my dad's lungs during a CT scan.  Mind you, this was a follow-up CT scan for something else, and that growth wasn't there before...so it grew in the space of a couple of months.  So how rapidly this growth appeared is what alarmed everyone, plus where it's located.

The doctor himself scheduled an appointment with the specialist for next week.  They're going to go in, take a look-see, grab a sample for testing.  The doctor told my parents it could be anything and that they would not know until they were able to take a look at it.  The doctor also put the kibosh on dad flying:  dad wanted to wait until after the trip, but the doctor said that given how fast this thing sprouted up, who knows what will happen in a few weeks.  They also can't take the risk of the lung collapsing due to the plane ride.

Where it's positioned apparently makes it inoperable:  right lung, in the bronchus, at a fork.  I hope they can debulk it because it's almost closed off the bronchus.  If it were an inch up or down, they apparently could have removed it and put a tube in.

Lung cancer is a very real possibility:  both of my parents are (my dad did cut back drastically in the last several years but never fully stopped) die-hard smokers, so if they weren't smoking the cigarette itself, they were taking in some of that secondhand smoke.   And the Big C is no stranger to our bloodline, unfortunately.  It's appeared throughout the family in many different types.

I realize that my father is no spring chicken.  He's on the downward slope of the 70s and in addition to this, has had cardiac problems all of his life.  To be honest, I'm sometimes surprised he got as far as he did.  On the other hand, we all say that since he sees the doctors so frequently, he'll probably live until 100.  Still...

*sigh*

I'm trying to figure out if I (and little one #2) should fly out to New York and be there for the procedure, or go the following week, or go maybe later in the month.  I couldn't leave any earlier than Sunday.  I could go for a week and come back...I'd have to cancel three days of work, but I think this qualifies as a damn good reason to cancel.  If I waited a week, I wouldn't have to worry about work, but I'd be cutting it close to Christmas.  Or maybe we'll all go at the end of the month once the better half is off.

Better half is in a spot of denial...he's holding out hope that my father will be able to board a plane and fly across the country mere days after this procedure.   I told him several times that the chances of that happening are on par with snowballs in hell.   He continues to be in denial.

In a sad--as in Greek tragedy way--I'm not surprised that they discovered this now.  When I was growing up, his health would always go south around this time of year.  He was usually hospitalized for some part of December because of his heart, though he was always sprung before Christmas.  One year he cut it close though, discharging on the 24th.   For a few years his health perked up and he managed not to have the December hospitalizations.

*sigh*

I can't believe it's already December.  Two birthdays this month:  little one #1 and mine.  Then Christmas.  I've scheduled all my work shifts for the first half of the month so after December 15, I am off to enjoy the holidays.

I went to work on Black Friday because you can't pay me to shop on Black Friday.  Seriously, any day of shopping where people are killed in the name of bargain-hunting is not a day for me.  Plus I detest crowds.  So I'm willing to forgo rock-bottom sale prices to both live and not have to deal with parking my truck in a crowded mall parking lot.

Anyone, I went to see a coworker.  It was part work, part break.  I had to update him on a mutual patient (no HIPAAs were violated in the making of this conversation), and then after that, we fell into chatting about random topics.

I told him that as horrible as it sounds, after a patient discharges, I really don't care about them anymore.  I know that it's not the most compassionate, "it's expected of a nurse" response, but the reality is that I can't.  At least, not if I don't want to burn out.

I take the best care of my patients that I can whether they're my patients for five weeks or five minutes.  But when I leave for the day, I put them mentally away.  It's very rare that I let my mind dwell on a patient after I've clocked out...usually it's a very sick one that I hope will be OK in the AM, or one of my frequent flyers who is in the facility so often that when admitting calls to admit them, I can give them the report.

When a patient discharges, I wish them the best (and sincerely mean it), but once they're out that door, they're also out of my mind.  Again, the rare exception may be the frequent flyer that I might hear updates about from coworkers or other patients who've seen said patient in the community.  But once the patient discharges, I have to move on and focus on the patients who remain...as well as those who will soon arrive.

Part of it is to avoid my burning out mentally and emotionally by always subjecting myself to the service of others that I forget my own self-care.  I think they call it "compassion fatigue."  I learned from my pediatrics rotation how bad burning out could be...hence why I'll never work peds.  I could never mentally leave those kids at work.

I also think that part of it is because of the patients themselves. After years of dealing with patients who need help and don't want to be there, who go AMA, or who keep coming back because the minute they leave the facility they choose to drink/drug again, or choose not to take their meds anymore, or decide going to follow-up care isn't worth it...well, it's hard not to get a bit jaded.

Not so jaded as to provide the best care that I can, though.  And I do have tremendous compassion for my patients...while they're my patients.  But I have to set limits on that compassion for my own mental and emotional health.

The next challenge

The 30-Day Shred is the most agonizing 22 minutes of my life.  I struggle through it grunting and panting.  For whatever reason, I have difficulty with a different exercise each time:  either certain muscles are sore, or I just can't get the form right, or I get fatigued really quickly.  I'm cursing anyone and everyone--especially Jillian Michaels--in two languages.  When I get to the final stretching period, I stay face down on the rug and pray for a swift and painless death.  Then two days later, I go and do it all over again.

The scale isn't budging, but the pants are fitting better and better.  And I've been told by someone that I've really lost weight, so I guess it's working...or they're being too kind.  Who knows?

Soreness notwithstanding--I have a torrid love affair going on with my bottle of ibuprofen 800mg--I do feel better overall  Not that I'm ready to run a marathon...but I feel more "fit" than I did at the beginning of the month.

Anyhow... 

I requested that my transcript be sent to myself as soon as my degree was conferred, so when it gets here, then I can officially sign things with "BSN."  I guess I technically could use BSN in my signature since I did complete all requirements, but I feel weird doing it without having my degree in hand.  Or at least having a transcript in hand stating that I have earned that degree.  

Since I no longer have classes to take and clearly still need another outlet for my energies (besides exercising, I've read several books, already knit a shawl and two hats, and have cast on another pair of socks), I decided that it was time to embark on the next challenge:

It arrived in the mail earlier this week.  I'm joining the elite...or going to attempt to, anyway.  From what I hear, this examination is truly hell on wheels.  So I decided that if I'm going to make the Spring 2014 test, I need to start revising now.  I have this guide, I have a bunch of addictions manuals, books and journals to go through, and I've made arrangements to pick up more hours working shifts in the addictions programs over the next couple of months.  I also need to sort through my CEUs and see how many addiction ones I have finished, because I will need to have 30 CEUs completed before I can test.

I feel a bit better doing this.  I've been working so hard at school for so long than I feel like I'm wasting my time if I don't work towards the next thing. 

It's been a busy several days.  Between both jobs, I've been everywhere:  ER, outpatient, partial, step-down, back to the ER.  Thanksgiving tomorrow....no four day weekend for me...I'm off tomorrow, but on for Friday and Saturday.  I'll do my Black Friday shopping online.

I've done the 30-Day Shred for five times now.  Considering I started on Halloween, I'm averaging about one workout every two and a half days.   I haven't lost any weight, but some of my pants fit a little better.

I've also gained some endurance.  When I first started, I was only able to do five consecutive push ups before stopping for rest.  Now I can do eight consecutively.  I went from doing 15 in a minute (be aware that the minute is broken up into two 30-second sections) to doing 30 in a minute.  That is serious progress for me.

I'm also getting through the DVD with fewer breaks.  It's not pretty, and I prefer that no one be watching me as I workout as I'm sure I look as much of the uncoordinated wreck as I feel like I am.

I had to modify one exercise.  For reasons unknown, I can't mock jump-rope without having severe pain in my right tricep.  Even just the jumping without the mock hand actions hurt.  I can do the jumping jacks with no problem or pain.  I just can't mock jump-rope.  So I march in place for that segment...it's probably nowhere as effective, but it enables me to keep going.

I'm on a new assignment this week.  I'm vaguely familiar with the program that I'm going to cover, but it will be trial by fire.  Should be interesting.  It's at my main facility, so that means guaranteed shifts:  no worries about cancellation.  Three full days, one half day.

I also have no three-day weekend...oh well.  That's nursing for you.

Ow

As the first days of the rest of my life play out, I started doing an exercise workout:  Jillian Michaels' 30-Day Shred.  Tagline is that I can lose up to 20 pounds in 30 days.  Now, the nurse in me knows that losing 20 pounds in 30 days is a.  not necessarily safe, and b.  not likely to last for the long haul.  I'll settle for losing 5 pounds in 30 days.

This is a short yet intense 20 minute workout.  I need nothing but the DVD, a workout mat, hand weights (which I didn't have until today, but I didn't let that stop me), sneakers, and 25 minutes to allow for a little warm up and cool-down.  Little one #2 providing commentary optional.

I opted for the easiest workout level and followed the modifications for beginners ("If you feel like you're going to die, follow Anita").  It was TOUGH.  Seriously.  I would have wimped out and burned the DVD if it was going to be any longer than 20 minutes.  I was so sore that I needed three days and plenty of ibuprofen to recover...and mental note to myself:  do not attempt a new workout before working inpatient.

I wasn't entirely ow-free when I did the workout the second time, but I also knew that if I didn't get back in the saddle as soon as I could, it'd just get harder and harder.  So on day three, I did the workout again.  The second time went a little easier, and I wasn't quite as sore.  I didn't need as much Motrin.

Since I was feeling a little better after this workout, I waited two days and did it again.  The workout is getting easier.  Yes, I still feel sore.

Anyhow, the rate I'm going, it's going to take me about 90 days.  Thank God I didn't opt for Power 90X.  That might have taken me half the year.

*sigh*

Rough shift recently:  everything that could go wrong at work did, and it was out of my control.  I can't go into too much detail without violating HIPAA or anonymity...but it seemed like very little went my way, and there was nothing I could do about it.  It was one of those days that I'm half worried that the agency will tell me the facility doesn't want me back anymore because of how bad the day was.  I'd be the perfect one to throw under the bus for everything because I was one of the few agency nurses on hand.  Didn't do anything wrong AFAIK nor was told as such...yet my thought is, Meriwhen, meet Bus Wheel.

Yes, I know I'm being a little paranoid.  But it was THAT bad of a day.

Oh well.  I did do my best and got through it.  And in the long-shot that I'm no longer desired by the facility, I'm sure my agency will let me know before my next scheduled agency shift.

Next week, I've got a week of guaranteed shifts at my main employer...and after today, I'm already looking forward to it.

You are cordially invited to feel guilty

I'm sitting here, watching ID and drinking iced tea while little one #2 is asleep across my arms and abdomen.  I can't put him in his crib as he will wake up.  He's not a napper so this is rare, and I want it to last.  Considering that at 1830, I can put this child in his crib, say "good night" and walk out of the room with nary a protest, I'll take the lack of napping skills and remain pinned to the couch for now.

Still waiting on that final grade.  I feel like I can't relax and accept that it's truly over until that grade is posted.

I received an invitation for Sigma Theta Tau.  I'm not surprised--I knew that I was going to be invited.  But still...it's rather nice to be acknowledged by a professional organization.  It'll be good on the resume  and it will be a great networking opportunity, especially since I can have a dual membership with my local chapter.  There are two local chapters I can join, and I've chosen the one that I'll affiliate with once I'm inducted because I'm familiar with who this chapter's leader is.  I'm looking forward to taking part in STT.

Of course, such an invite doesn't come for free...like any Greek organization, there's initiation and membership fees.  Fortunately, I worked enough in October to more than cover it.

Speaking of work...

I turned down guaranteed hours on Thursday.  I'm on call for Friday so that's 50/50 as to whether I'll be going in.  But I received an offer for Thursday and said no.  I figured that as it was Halloween, I'd take the day off to get little one #1 and his costume ready, and then be fresh for walking around the neighborhood while I hold little one #2.

I worked a lot in October, and I felt like little one #2 needed some quality time with me.  I have enough guaranteed hours in November to cover my childcare costs.  Actually, the way my paychecks fall as well as the extra hours I got in October, I'll have paid for December's childcare on November 1st.  So technically I could take November off and December will still be covered.

The better half told me to enjoy the down time.  He's thrilled that school is finally over and that I have free time again.  He felt (and I'll admit to this) that sometimes little one #1 got lost in the shuffle because I spent a lot of my free time doing homework--he'd get shortchanged.  So he was supportive when I told him I opted out of work Thursday to be there for little one #1.  And of course, little one #1 is ecstatic.

So why do I feel guilty for turning down the hours?

*sigh*

I should just relax and enjoy the time off, but I can't.   I should enjoy the little lump of love that is unconscious in my lap because he won't be a little lump forever.  I should enjoy the time with the older lump because he's going to be grown up before I know it.  And I just keep thinking that I should have signed on for Thursday.

But I'm not going to.  I'm going to focus on the kids.  To help myself resist, I already told my babysitter that I had plans on Thursday and would not be needing her services.  It's going to be tough...and if I get cancelled on Friday, I'll feel even guiltier.  But I need to prioritize.   Kids first.

Sometimes, I wonder why I'm so hard-wired to work.

Stuff

So, on my life after school, I've steam-mopped all my wooden floors, got a FitBit and started working on walking 10,000 steps a day (high score so far:  5,500), played Club Penguin (I'm in charge of feeding the little one's 11 puffles because he forgets to), started reading actual non-knitting books, and knit a shawl...well, it's a skimpy shawl.  More like a scarf, actually.  It's called a Wingspan if you want to look up and see the shape.  It's green and rather pretty but it's too small for me.  I like shawls that are practically blankets, or at least come half-way down my arms, so I'm sending it to a friend for Christmas and will start another (and larger) one for myself after I finish the hat I just cast on.

Anyhow...

Still waiting on the final grade.  I'm pretty sure it will be an A and I'll have my 4.0 unless I really tanked something that wasn't graded yet.

At my main facility, I'm finishing my assignment up:  last day is tomorrow.  It was a nice run there...and I admit to feeling an occasional twinge of regret that I didn't apply for the part-time position myself.  But it did not fit into my long range plans, and so I didn't want to do it knowing I couldn't give them the long commitment they were looking for.  I'm sure I'll be back there again one day though.

Meanwhile, I oriented at a new site and have the opportunity to pick up more hours, including some weekend ones.

And the agency has been calling me like crazy.  Someone must have gotten fired.  Anyhow, I gave them my next month's availability so we'll see how many days I'll get.  Actually, a couple of weeks ago they had called asking if I'd be interested in something long-term.  I told them that because of school (which I was still in at the time) and the baby, I prefer to keep it month to month right now.

So for all of their mad calling, we will see how often I'm cancelled.  I've scheduled enough guaranteed shifts this month to pay for December's childcare, so there's no stress if I don't get any shifts from them.  Though it would be nice to make some extra money to start on the Christmas shopping as well as on little one #1's birthday shopping.

I have the day off from work.  I woke up this morning and didn't know what to do with myself.  I have no papers due, no reading to do, no discussion questions to answer, no projects to work on...

I'm having a hard time accepting this.  I can't relax.

It is finished

I turned in the last assignment one day early.  It is finished...I can't believe it's finished.  Four years...

I won't officially celebrate until I receive a grade for the class, but I can't help but feel as though a weight has been lifted off of my chest.

It was truly a Hell Week, since little one #2 ended up coming down with a viral infection.  I had to do a lot of typing with a feverish and vomiting baby lying on me because if he wasn't lying on me, he'd start shrieking.  He's better now, thank God.  But it was rough.

Off to celebrate with some hot chocolate and then going to bed early with a non-nursing book.

Hell Week begins

The last time I had a Hell Week, I was a pledge.

It's the final two weeks of Capstone.  Well, it's really the final week, as everything needs to be turned in by 2100 on Monday.  After that, the class is pretty much done even though we still have a week remaining.  It's a very odd schedule for a class.

In this Hell Week, I have 8 projects due:  a PowerPoint presentation of 20 minutes' length, an evaluation of said PowerPoint, a journal entry, a reflection paper, a resume, a discussion question, and two discussion question responses with substantive content.  The first three are due tomorrow night; the remainder except for the responses is due by Sunday night.  I'm on top of the first three assignments.  The rest, I haven't even started.

Fortunately, I'm spending the next two days at my main job and it promises to be mellow, so I'm hoping to get some work done while there.  Not going to bank on it, but I'm e-mailing homework to work on just in case.

And then...then it's over.  It's really and truly over.   I'm receiving all of these graduation announcements and e-mails and it's so surreal.

Work was interesting today.   I got to give my PowerPoint presentation a trial run with a couple of my patients who were sorely needing some med-ed.  Well, I didn't show them the slides, but I knew the content by heart.  I think some of the message got through to them.

Interesting and unrelated fact:  my sorority did not permit pledges to drink alcohol, regardless of their age.  Kind of goes against the Greek party-animal stereotype, doesn't it?  Though any days of partying on my part are long past.  The last mixed drink I had was hot chocolate with Almond Joy coffee creamer.

Cancelled...oh well.  It'll be a good day to get ahead on next week's coursework.   Because of when the deadlines are set in this course, anyone (not just me in the Pacific Time Zone) really needs to work ahead to make them.   Three more weeks...

Meanwhile, I realized that I never heard back from that psych hospital that I sent my resume to.  Oh well...again.  

I don't think it's solely because I'm not (yet) a BSN.  I think I need to do some work on my resume to make it look good.  I've been brushing it up, but I think it really needs an overhaul.  Maybe I'll work on that a little after I get some coursework done today. 

So...

I took a chance and shot the manager of the ICU an e-mail asking about the part-time position--not that I wanted it, but what they were looking for as far as scheduling goes.  I decided that given the up-and-down scheduling from the agency, that I'd rather just focus on going inpatient at my main job.  I wrote a few days ago...no response.  So either the manager just hasn't gotten to it yet for whatever reason, or has gotten to it and hit the Trash button.

*sigh*

I can't say I blame her if it was trashed.  After all, new graduate job hunting season has officially started and I'm sure she's inundated with messages from new grads.  I'm sure she read my message and decided that I was probably just another internal applicant pleading for a chance.  Then again, the "RN-BC" after my name should have been a hint I'm not quite the new grad...especially since the job posting stated that ANCC certification was preferred.

And so is a BSN.

Four more weeks...well, not really.   I found out from my lovely school that degrees do not get conferred until mid-December regardless of when the coursework was completed.  So even though the last day of class is October 26 or thereabouts, I have to wait for this degree to be conferred.

Again, *sigh*

So I don't know if, come November, I can legally call myself Meriwhen, BSN, RN-BC, or if I have to wait until the official conferral of the degree.  I would think that as long as my transcript stated that I have completed all the requirements, I could start saying, "I'm a BSN!"  But then again, who knows when my school will do that...they probably won't change the transcript until December with my luck.

It's just frustrating that, after all these years to finally reach the finish line, to find the finish line has been moved further back.

Oh well.  There is nothing I can do about it.  Say the Serenity Prayer and focus on the now.

Let's see if the agency cancelled me tomorrow.  Fortunately, I've got a stack of shifts lined up at my main job in October so I'm not worried--I'll make my budget and then some...which is good as we have some house repairs that we need to get done ASAP.

Wild and crazy Saturday night

I'm doing some research for my Capstone project and other assignments.  My next discussion question is due Tuesday at 0600.  As I have both work and a social engagement on Monday, I'm getting a leg-up on the work.  This is actually going to be one of the last four Saturday nights that I'll be spending doing schoolwork.  It's a little bittersweet.

Unfortunately, I can't print any of my journal articles to read, as the printer is located in the little one #2's room, and he went to bed early because he was a crabby monster.  The lavender oil in the bath did help tame him.

My procedure went well.   Some discomfort, no complications.  I get the results in two weeks.

I was brought home and passed out.  I apparently woke up to feed and surf the web before passing out again.  I have zero tolerance for benzodiazepines because I never take them:  I only take them pre-operatively or pre-flight.  I don't like them, I don't trust them.  So much so that when my doctor wanted to prescribe an anxiolytic to help with some severe anxiety issues, I requested Vistaril.  Vistaril does not do much for severe anxiety...but to me, it was better than popping Xanax.

Anyhow, the next morning, I still had the Valium hangover...I'm not surprised though.  The half-life of diazepam is about 60 hours, meaning that it'd take 2.5 days to just get 50% of it out of my system.  For it to be considered fully metabolized, that takes four half-lives...in this case, 240 hours or 10 days.

I've kept the prescription bottle should I have to do a random UDS any time soon.  It's not likely, but you never know.

Procedure today.  Took my doxycycline (been taking it for a day, now).  Have my Motrin and my diazepam ready to take when I'm there.  Got to love twilight sedation.

I turned my homework in early this week because I know that 10mg of diazepam is going to be render me non-functional as far as intelligent thought goes.  I also have brought a better book to read while waiting for the diazepam to kick in:  Edith Wharton's Age of Innocence.  I hope it's much less depressing than Less than Zero was.

Mind you, I could bring my substance abuse handbook and read that...that would really make them think.  And it may even counter the mental effects of the Valium.

I also need to get some milk ready for the Milk Tiger for the evening, as 10mg of diazepam is going to render me unable to nurse until it clears.

I got offered another shift at my main job next week, so I need to cancel on the agency.  Guaranteed hours trumps every time.  Next month is definitely shaping up to be a feast and not a famine as far as work goes...provided I'm not cancelled on short notice.  But since most of my hours are at my main job, I don't have much there that could be cancelled.

There is also a part-time day ICU position going.  While I really want to get into psych-medical, I have to admit that this position is calling to me.

I'm hoping that the government isn't going to be shutting down next week, as that may directly affect us.  The other half--being military--may not see his paycheck next week.  It is a worry...and an annoying inconvenience.   I can't really do too much about it though, unless I somehow develop the power to control governments.

We have enough in savings to weather the storm for a few months, and he will get back pay so the savings would be replenished.  Though hopefully any shutdown would only be in terms of weeks, not months.  If we need to, I could call the agency and start picking up weekend shifts.  Or I could just make that plunge and go full-time earlier than planned.

5 weeks to go

Capstone is up on my Blackboard, so I've been downloading materials and updating the calendar.  The deadline for assignments is 0800 Texas time.  That means 0600 my time.  As I don't see myself getting up at 0-dark-30 to submit assignments...I put the due date for all assignments as the night before.  So that's a bit of an annoyance, but it's nothing I haven't had to deal with before.

This means that I have to submit some of Week 5's assignments before Week 5 even begins.

But at this point, I no longer care.  In 5 weeks, I will have completed this course and thus the BSN program.

No textbook needed.  No tests.  The discussion questions are back.  Lots of writing, but after Vulnerable Populations, it can't be that bad.

In other news, the weather finally started to change.  There's a bit of a chill in the air in the evenings.  We went to see my sister and her family yesterday, and we dined on Thai on the patio.  Good thing my pad thai was spicy enough to keep me warm.

Thank God

Surfing the nursing forum...at least once a day, someone thanks God for something.  Usually it's for passing the NCLEX, or getting a job.

I'm all about God.  I'm Catholic and not ashamed to admit it.

But I'm also reminded of the George Carlin sketch...why do we only mention God when it's a good thing?  You never really hear him mentioned when it comes to the bad things.  For example, you'll never see, "I failed the NCLEX, guess it wasn't part of God's plan to have me pass just yet."

Or what if it's something that God had nothing to do with?  I'd like to think that my grades are due to my hard work and not due to divine intervention...if that wasn't true, then I'd spend more time in church saying Rosaries than studying my textbooks.

Or no one ever thanks anyone else but God.  I haven't seen any references to thanking Buddha or Allah or Yahweh or the Goddess or the Spaghetti Being for doing well on a test.  Jesus Christ gets plenty of press though...but I suppose that's the same as God, isn't it?

For once, I'd like to see someone post, "I passed the NCLEX, and I want to thank Cthulhu for making this possible."

Speaking of which, I really need to find a Catholic church around here.  The last area I lived in was heavily Baptist and you couldn't find a Catholic church anywhere.  Out here, there seems to be a lot more of them around, so I should find one to start attending.

It's a proven fact that the more un-toy like something is, the more a baby will want to play with it.  Case in point:  little one #2 is sitting here on the bed with me.  He has all the toys he could want at his fingertips, but he's chewing on the better half's belt and letting out the Happy Baby Squeal.

So the feast eased up a bit:  I was cancelled by the agency this week.  I've learned that they agency has placed a full-time agency person in there, so they're going to get priority when it comes to scheduling.  Fortunately, my main job wanted me on short notice, so I didn't lose any hours this week.  We'll see if the agency will pick me back up at the end of the month--I'm taking some time off to have the follow-up to an earlier medical procedure done.

But going back to the full-time agency thing...I have to wonder why someone would sign on for that.  They're getting the standard agency rate--which is actually less than what the equivalent permanent employee gets--and no benefits.  Plus if there's enough permanent staff there, they can get cancelled.  The only perks that I see are priority in scheduling, some flexibility (though they are being forced to pick up every other weekend), and the ability to walk tomorrow.

Still, I guess it worked enough for someone to take it.   Who knows?

I have the day off, which is nice as it's grey out.  It's a good day to put something benign on the television for background noise, sit with little one #2 and work on the shawl I cast on last night.  Grey days are rare out here...what would make it perfect is if it rained.  But that may be asking for too much.

I'm alive

I'm waiting for a sleeping baby to wake up.  One rule of parenting that you learn really fast:  never wake a sleeping baby unless the house is on fire.  As long as they're breathing, that's all that matters.

The second rule is to never try to make a happy baby happier.  If they're happy staring at a toy in the corner, let them stare.  

So, Vulnerable Populations was such a mixed bag.  A lot of hard work and research.  Very interesting and fun to learn about this little community I live in.  Not as much fun turning in 30-50 page papers each week.  I want to go plant a tree in honor of the ones I've killed during the course of this class.   

The course was straightforward, though it felt like I had to teach myself most of it.  And like Research and History part 2, it is not without some drama.  I commented on it--and probably pissed off a few classmates in the process--but I'm largely staying out of it, as I think the school's in the right on this one.  It's expected that even if students aren't pros at APA yet, they should know the need to cite your sources.  Ideally, cite it correctly...but even if you have to cite it incorrectly, at least cite it.

The two history classes and Research pounded that well enough into my head.  I may get dinged--and often--for craptastic APA and Turabian, but I've never been dinged for plagiarism.

It's interesting watching people argue about how they shouldn't be penalized because they didn't cite as they should have.  Oh well.

Anyhow, I got an A.  I haven't taken the last quiz yet, but even if I don't, I still have the A.  So I may actually end up with that elusive 4.0...we shall see.  One week off and then it's Capstone.  The final class.   I'm already registered for it, and the tuition is paid for.  I'm ready for this to end.

I've been working 2-3 days a week.  Once again, it's gone from famine to feast in my world.  I wasn't cancelled from the agency three days in a row, which is unusual.  Someone must have gotten fired.

Plus my main job has offered me the chance to cover one of their sites 3 days a week starting in late September through October, and possibly beyond.  Of course I said Yes.  So they're going to check their staffing, confirm the dates and let me know.  In the meantime, I'm holding off on canceling with the agency for that month, just in case.

In other news, an opening for psych medical opened up...but full-time nights.  It was all I could do not to cry.  *sigh*  My time will come one day.

Bleh

Last night, my throat started to get scratchy.  Today, I have a sore throat, runny nose, headache and fever of 101 post-Tylenol.  Whee.

So I've been on the couch with little one #2 watching some show about extravagant Sweet Sixteen parties.  I can't believe what parents pay for these things.  I can't believe how whiny and entitled some teenagers can be.

Haven't done any schoolwork because it hurts to keep my head upright.   

I have to work tomorrow....the fever better break by then or else I'm going to have to call out and see my PCP. 

And so it begins...

The class instructors have decided that since so many of us purchased the old (and apparently incorrect) textbook, that they will upload whatever chapters of the new (and apparently correct) textbook so people do not have to rent or purchase the new book.  They're going to go between both books.  Of course, this comes after I have already rented the new book, which will arrive here today.

So I ended up not getting anything done for class yesterday as the announcement came through Blackboard while I was at work.  By the time I got home, we had to go right to the little one #1's school.  By the time we were done for that, it was dinner and then collapsing--I started reading and fell asleep on page 4.

Yup.  Not cancelled for a change.   And I'm guaranteed hours at my main job on Friday, so I've hit my goal for this week.

To be honest, with all of the cancellations, I've started to get into the mentality of expecting NOT to go in and planning my days accordingly.  I wouldn't schedule anything in stone, just make lists of things that I needed to do and loose plans that could easily be changed or cancelled.  So I had figured that yesterday would be the same way...but I got the "come on in, you're needed" call.

It was an...interesting...day.  More colorful than usual.  That's all I can say without running afoul of HIPAA, so you know it had to be a doozy.

Anyway, near the end of the day there, I was chatting with another agency nurse.  She said something interesting that made me think.  She believes that at times, she gets cancelled because the agency is "punishing" her for canceling on them.  She stated that she called out once for illness and was cancelled for about a week and a half.

So it got me to wondering...how are cancellations really determined?  Does the facility decide who they want, or does the agency decide who they're going to get?  And if it's the agency, how do they decide? Do they rotate the cancellations so its fair?  Do they go by seniority and cancel the new nurses?  Do they go by who scheduled first and cancel those who signed up later?  Do they play favorites?  Or do they take the chance to settle some scores and do a little quid-for-quo?

Of course, this is not a question that I could ever ask my agency...not if I want the honest answer.   Not that I think the worst because I don't.  But I'm sure their cancellation guidelines are not something they're eager to make public knowledge.

I'll admit, my primary job will always get priority because a.  it pays a hell of a lot better, and b.  I really like working there.  I'm proud to be one of their employees and hope to stay there for quite a while.  So if there's ever a conflict between the two facilities, my main job will always win and I'll always cancel on the agency.  If they do not like that, so be it.  But at least I give the agency the courtesy of canceling as soon as possible; whereas I get the news from them about being cancelled two hours before I'm supposed to go in.  And it does get tiresome at times waking up at 0400 for what turns out to be no good reason.

But I knew that was the deal with being an agency nurse from day 1--I was under no delusion that it would be otherwise.  So I accept it as fair.  I don't always have to be fine with it, but I accept it.  They're not doing anything wrong.

Oh well.

Haven't heard back from the hospital that I shot my resume off to on Friday...I'm trying to remember that the job hunt is not an instantaneous process, just like I tell people at the forum.  I figure if I hear nothing this week, next week I'll go in person to complete an application.

Now off to start reading for Vulnerable Populations.

This is an ominous start to things...

Apparently, they're using a different book for the class.  The instructor is also someone different than originally mentioned.  And they uploaded the wrong syllabus.

Reprinting syllabus and refusing to reopen Blackboard until Monday, when I will download everything again to make sure I have the accurate content.  Now off to order the correct textbook.

My next class is up in Blackboard, so I've downloaded the syllabus and updated my iCal with all of the due dates.

I'm going to have to do two field assignments.  I hate field assignments...I really do.  I'm never entirely comfortable just going out there talking to strangers.  I have no issues doing it with my patients at work but otherwise...yeah.  I actually dreaded this class a bit more than I did Research because of that.  

I don't think it's social anxiety.  I think I just have a touch of Axis II that makes me not the best at social situations.  Seriously, I wouldn't be surprised if a psychiatrist pronounced me as having traits of avoidant and/or schizoid personality disorder.  

Or I could just be somewhat shy with strangers and that's it.  Not every quirk has to be a major psychiatric issue, you know?  One down-in-the-dumps day does not a diagnosis of depression make.  Likewise, not wanting to interview people for a project doesn't mean I've definitely got a personality disorder.

That's one thing about us who are in psych:  we tend to overanalyze and self-diagnose, which isn't necessarily a good thing.  They warned us about it in the first day of nursing school...and yet before the class was over most of us in the class had self-imposed Axis I and II diagnoses.

Anyhow...

Given that this is the last class before Capstone--plus the fact that there's no way of getting out of this class--I'm feeling optimistic that I can do this.  Only two more hurdles to cross before I can put BSN after my name.  

Actually, when I'm done I'll be RN-BC, BSN.  Or BSN, RN-BC.  And then once I apply for public health nurse certification--which I can do after graduation--I can add PHN to the alphabet soup.

I had thought about reading ahead for this class but decided not to.  I've always been a firm believer that breaks from school should be just that:  breaks from school.  I shouldn't have to be doing schoolwork on breaks...if I wanted to idly thumb through a textbook or guide, that's one thing.  But otherwise I should be enjoying the time off while I can, since the next few weeks will be busy enough.

I have had it!

Cancelled yet again.  Time to do something about this...so I just shot off my resume and a cover letter to a nearby psychiatric facility that is looking for per-diems.

Me thinks it's time I parted ways with the agency...or at least not rely on them as job #2 anymore.  Job #3, perhaps.

So I sent it off...let's see what happens.  Though I do need to remember that sending a resume on a Friday afternoon will not necessarily result in a same-day reply.

I'm it

Phone tag is over:  the recruiter called me back as I was vacuuming the house.  She was sorry she couldn't contact me again sooner...I'm sure she's very busy dealing with the throngs of new graduate nurses jockeying to get in here.

Anyhow, we've pretty much agreed that the best way for me to get into medical nursing at my facility is via psych-medical.  There's few med-surg training programs and the managers on the units prefer experience in the specialty.  The requirements for the ED program are indeed stringent...but we both kind of knew that.  Whereas my psych background makes me a decent candidate for psych-medical.  I did interview with them once before when I first arrived here, but I didn't have the BSN--in fact, I had just switched schools and was about the start the new (current) BSN program.

Unfortunately, there isn't anything open in psych-medical at this time.  Fortunately, she is the recruiter for that department and will keep me in mind.  She also feels my chances will be better once I have the BSN in hand.

So now I just stay the course and wait.  And starting to brush up on the medical nursing knowledge couldn't hurt either...even if I don't get a position right away, it's still darn good stuff for me to know.

Still playing phone tag with that recruiter...it's not very encouraging.  I tried calling twice this week but all I got was her voice mail, so I left two messages.  That's it from my end:  the next call is up to her.

Another cancellation...going for that part-time position is looking better all the time.

In other news, my Vulnerable Populations textbook has arrived.  I may start reading it just so I'm ahead of things once the class starts in a couple of weeks.

Well, this is a first...

Coworker:  Is that your real hair color?

Me:  No.

Coworker (actually starts checking my hair roots):  What is?

Me:  ...

I actually wasn't insulted:  I'll admit my hair is dyed.  I mean, it's a fair question to ask someone if they have one hair color one day and another hair color the next day.  But I have never been root-checked before...this happens to be an awesome coworker so I wasn't upset.  More amused than anything.

I suppose it could have been worse.  They could have asked a more indelicate question.

For the record, it's dark ash brown.  I discovered that when I went nearly a year without dyeing it due to pregnancy and childbirth...and apparently, my real color has darkened over the years.   Which means I will now stand out even more among the sea of blue-eyed blondes in family photos.  

Actually, it was seeing the photo of my blue-eyed blond son that prompted my coworker to ask about my hair color.

Currently the hair is reddish brown.   L'Oreal Healthy Look Creme in 5CB if you want to play along at home. 

I have to wonder why my agency is advertising for nurses needed stat; they keep canceling me and I'm available.  In all fairness, I am limiting what shifts I am available for, and there's stiff competition between regular staff and other agency nurses.  I'd bet that if I put in for NOC or weekends I'd have no problem getting shifts.  So I guess I really don't have anyone but myself to blame for not getting enough hours.

I may actually have to put in for a weekend here or there if I keep getting canceled during the week.

Though I am thinking of making the plunge into non-psych.  I think it may be time for me to do it.  Not that I'm unhappy in psych...I just feel restless.  I'd also like to get this experience while I'm still in CA, the land of nurse:patient ratios.  I'd rather not jump into the medical nursing pool and be stuck caring for 8-9 patients while I learn the new ropes.

While I'm not planning to switch tomorrow, I figured that I'd start laying some groundwork and see what I need to do in order to transition over after I finish the BSN.  Why not start where I currently work?

So I dropped a note to my hospital's recruitment office about what opportunities out of psych may exist for me.  Surprisingly, a recruiter called me back the same day.  Unfortunately I was with a patient and couldn't take the call, so now we're playing phone tag.

There's always psych medical, but nothing open in there right now...plus they want a BSN.  Granted, I'll have that in a few months, but still, there's no accounting for preferences.

There is a ED nurse training program opening up at my facility, but they prefer applicants with medical nursing experience.  In addition, they would be starting in the next couple of months, and I'm not ready to go back full-time just yet.  I really want to wait until little one #2 is a year old.

Meanwhile, someone told me about another ED nurse training program--outside of my facility--that is worth checking out.  Three months of training, and then there's an internship I could apply for.  I have far better chances of getting into this program, so I may give it an honest look.

I'll look outside of my current facility as little one #2 gets closer to one year old.  Several have recommended LTAC, and there's a few places in the area that have LTAC units.

Of course, several psych opportunities cross my path right now...but I'm going to hold off on most of them.  Though there is one that I am seriously considering.  Part-time at my current facility, only having to work 3 days a week at normal hours.  It is tempting...then again, I'm not sure I want to sign on for it when I'm looking at leaping out of the psych pool.

Cancelled...tough week.  Not much I can do about it though.

The only physical traits my sister and I share are that we are both tall (though she is a little taller) and we sound exactly the same on the phone.   That's it.   Some people say we have slight resemblances in facial structure but we don't see it.

She has straight blond hair, blue eyes and tan olive skin.  She's also willowy and thin.  I am pale with dark hair, dark eyes, and curves.  My frame is more athletic and willowy has never been used to describe me.

We were out to lunch today and she introduced me to her friend who was convinced that I was the sister-in-law, not the biological sister.  

It's always been like this, so we're both used to it.  

In other news, I was cancelled once this week...hopefully not twice.  If it is twice, I can't pick up anything on the weekend as it's ACLS renewal time.  At least I had one guaranteed shift this week and next week I'll have another one.

Financially, I've made my childcare cost quota so anything else from this month is strictly profit.  Still, I'd like to do a little better than just barely breaking even.

I also decided to put off the CARN certification until next year.  Between the cost of the test and the CEUs as well as the fact that I've have to take this test in October, I'd rather just focus on finishing the BSN right now.

It must have been something in the hospital water

I was proposed to by four patients.  Only one required redirection for his behavior:  the other three kept themselves in check.

One of these three tended to hover near me.  Long story short:  he hadn't had a pleasant time there so far and was anxious, and I guess he found my presence comforting.  Quiet kid, no behavior problems at all.  It made for an interesting situation when I had to relieve someone on a 1:1.  The patient being watched (who wasn't one of my admirers--in fact, he didn't like me one bit), kept wandering around the unit.  Five feet behind him (just outside of an arm's swing) is me trailing him.  Five feet behind me is my admirer trailing me.  The charge nurse thought this parade was very amusing.  

Agency work has been going well.  I got both my days this week--I changed my schedule so I wouldn't be competing with as many other agency nurses for shifts.  Yes, there's not many agency nurses there anymore, but considering that the ones that are there have been working all this time while I'm returning for a leave of absence, they're more likely to be scheduled than I.  

I haven't been assigned the psych ER too much.  Most of the time, I've been assigned to one specific inpatient unit...which to be honest, I'm growing to really like being on.  I didn't think I would, but I do.  It's nice to have a patient population that doesn't completely turn over every time I visit.  I'm working with a good crew of people.  Staff there seem to like me.  Plus there's been too many changes to the ER:  too many new P&P, too many familiar faces gone...so I don't feel like I quite fit in there anymore.

Of course, having just typed that, the next time I'm scheduled, I'll probably get sent to the ER or another inpatient unit.

Next week, I decided to put in for three days.  I'm preferring to stick to the two days a week, but between the vacation and the upcoming tuition bill for my penultimate class, I decided to put in for a little extra this week.  One is at my main job so it's a guaranteed shift; even if I only end up with one of the two agency shifts, I'll still be ahead financially. 

Antisocial Personality Disorder

Those with antisocial personality disorders are all about themselves.  They do not have any remorse for their actions, nor do they feel empathy towards other people.  They will lie, cheat, steal, calculate manipulate, violate, disregard, act recklessly and basically do whatever they want for their own purposes.  They don't want to be caught but if they are, they're not sorry for what they did and they don't care what the consequences are.  All the patient with antisocial personality disorder cares about is whether their horse will win the race.

These are the ones who abuse animals either directly or indirectly, such as setting a cat loose in a full birdcage.  They may abuse other humans the same way, either directly or indirectly.  Instead of stopping a child from touching a hot stove, they may just sit back and watch the child burn themselves without intervening.  They lack compassion--the suffering of others may be an amusement to them or merely something about which they don't give a flying...anyhow.

It is said that a majority of prisoners have antisocial personality disorder...I'm not surprised.  Most people with antisocial personality disorder are male, but females can be diagnosed with it.  It shows up in dual diagnosis frequently, appearing in the company of a chemical or other addiction.

Like all other personality disorders, antisocial personality disorder is a bitch to treat because it's how the patient is hard-wired.  You can never cure them, just help them work with it.  But the problem is that by the nature of the disorder itself, those with antisocial personality disorder don't want to work with it because it's not what THEY want.  These patients are very resistant to treatment.

Someone once told me that patients with antisocial personality disorder are lost causes.  Some days, I agree with that sentiment.

They're not my favorite patient population to work with, and it takes a lot of self-assessment and self-control for me to do my job properly and provide then with the best care that I can.  It's hard not to appear or be judgmental and to treat them with the same level of dignity, compassion and respect that I'd give any other patient, especially after I hear what they've done.  These are one of the patient populations that take a lot out of me.  I find working with patients with other personality disorders, even those with borderline personality disorder, far easier.

Entering the homestretch

I have applied for December graduation.  I still have two more classes to go, but I need to apply for graduation now, so I did.   The next class (Vulnerable Populations) begins in mid-August, and the final class (Capstone) begins in late September.  My academic advisor reviewed my records to make sure that it's only these two classes left, and it is.

Providing I don't fail either of these classes, I will graduate with Latin honors no matter what grades I get.  I'm still holding out hope that I'll finally have that 4.0 (I came so close in the ADN program).  But ever since research, I'm looking more at finishing each class than getting a specific grade for them.  Research class--and talking to my group mates in it--made me rethink a few things.

I can't believe I'm going to finish the BSN this fall.  This has been a long road...way too long.

Swimsuit model...and happy anniversary

Four years ago today I found out that I passed the NCLEX.  Happy nursing anniversary!

As I wrote earlier, we're going on a small vacation this month. I dug out an old swimsuit which fit me...for the most part. It's passable...but not flattering. 

You see, even though I am now at my pre-pregnancy weight, this body does not look like it did before I actually got pregnant. Two children have wreaked their havoc on the body. The stomach is flabby from being stretched out, cut open and sewn back together. 50 pounds gained the first time and 41 pounds gained the second time...surprisingly, I do not have any stretch marks. My chest is still pornstar-esque in its dimensions, though it has shrunk slightly--I think I may now be an E cup instead of an F. 

The burn scar is pretty hideous...ok, that's not the children's fault in any way, shape or form. But the fact is that I can usually pretend it doesn't exist as shorts/pants neatly conceal it.  Swimsuits do not conceal it.

*sigh*

 So after work, I dragged the family two towns over to where a Lane Bryant that sells swimsuits exists. One day I will graduate from having to shop there...I'm not too far off: I fit into their smallest sizes. 

Anyhow, I go and look at swimsuits. Unfortunately for me, they just had a swimsuit sale and pickings are slim. If I were a size 22 or 24, no problem. A size 14 to 16, however… I did find one that could have worked. However, it had a corset-style lacing that made it impossible to get myself into…but that wasn't the deal killer. The deal killer was the $120 price tag. Seriously, if I'm going to spend over a C note on a swimsuit, it better be easy to get into and apply my sunscreen for me. Plus the fact that I intend not to be this size for the rest of my life, so why am I going to spend $120 on a swimsuit that hopefully I won't fit into a couple of months down the road.

So I went home and ordered a swimdress from their website. $50, which is more than I'd like to spend on a swimsuit…but better than $120. I just hope it arrives in time.

Resisting temptation

So almost all of my patients were paranoid and delusional.  Some of the delusions were so outrageous that it was hard for me to keep a straight face, but keep it I did.  These delusions are very real to each patient and me showing visible amusement would be both untherapeutic and insulting.  So I take them seriously.  I can decompress after hours.

I seem to be doing well with the agency work so far.  It's all coming back to me.  I go back next week provided I'm not cancelled.  I may not be given how few agency nurses I'm seeing on the scene, but we shall see.

I was offered hours today at my main job.  As tempting as it was, I declined.  First of all, I have some appointments today that I'm tending to.  I could have rescheduled them but I need to get them done with before we go on vacation.

Second...I've worked one day this week, and I will be working Friday.  I didn't want to take a third day.   I really want to keep working to two days a week so I can be there for little one #2, as well as little one #1 during the summer so he doesn't have to go into summer care every day.  I may make occasional exceptions, but I don't want to routinely take a third day because before I know it, I'm working three days a week, then four days a week.  Then soon I'm working full-time when I don't really want to be. 

So I said No, even though it would have been easy money.  But I'm glad I did.  I had my first appointment over and done with.  Now I'm hanging out with little one #2 and catching up on a few things at home.  It's nice.

Back in the hamster wheel

I am finally below my pre-pregnancy weight...well, pregnancy #2 anyway.  That weight was 198.  The scale today told me 197.4.  It took 2.5 months to get here, which is pretty much how I planned it.

Yay!

So now the next mini-goal is 190, at which point I will have lost 10% of my starting body weight.

No one believes I weigh what I do though...but keep in mind that I'm tall with a large frame, so I carry it well.   They also don't believe my age--I tell them that's the result of being pale:  I was forced to adopt the sunscreen habit early in life.

Anyhow...

The first day back for the agency went better than I thought.  A lot of faces have indeed moved on...though I was pleased to find three working on the unit with me.  The new grad (no longer new, really) who last year I thought wouldn't make it is still there...I'm delighted to have been proven wrong.  Seriously--I'd rather see people succeed...and feelings of schadenfreude do not really do me any good in the long run, so I try to avoid them.  A lot of the facility staff remembered me though, and asked what had happened to me.  So I showed off little one #2's pic a lot.

There were indeed changes to how things are done there, but I adapted pretty quickly.  They rearranged the staffing plan so there are actually more RNs needed on the unit, with the LVNs functioning more as medication nurses.  I didn't do triage but was placed in the back and given a patient load of 5.  They asked if that would be too much for me.  I remembered what life as a nurse was like back on the East Coast and tried not to laugh hysterically.  Oh California, how I love your ratio laws!

Everyone kept offering me help, which I didn't hesitate to request if I needed it.

The first patient I had to assess was inked to within an inch of his life and had generalized HI with a plan involving superglue.  Oh inpatient, how I have missed thee!

I was a little nervous at the start of the day, but by the end I felt pretty comfortable.  Hopefully I didn't make too many mistakes that they won't ask me back next week, but we shall see.

There weren't many agency nurses, as I had initially heard...scuttlebutt was correct in that the pay cut made a lot of them move on.  They also seem to have hired more permanent staff, though some of them seem pretty green as nurses period.  The last time I was working the unit, it was mostly agency nurses with few permanent staff--now that is reversed.  I'm not sure what this will mean in terms of my getting hours there...I suppose if I get cancelled during the week I can always put in for a weekend shift if I need to.  As long as I work the 4 shifts a month I need to in order to pay for childcare.

I should be working agency tomorrow, unless my primary employer dangles another carrot in front of me.

I have to admit I'm a little nervous about returning to agency.  It's been 9 months since I last worked for them.  I know that several nurses left the agency because of the hourly rate decrease.  A few more left for other various reasons, some good...some not so good.  And some of the permanent staff that I knew at the facility they're sending me to have left, though I don't know why...yet.  I'm sure I'll find out.

I'm not sure what P&P at the facility have changed.  I still have all of my old notes so I'm fairly confident.  Plus my agency has sent me several bulletins/updates over the last month so I can be aware of them.

Well, I guess it's another trial by fire...more like refresher by fire.  I survived the first time, I'll survive again.  If not, then I could always consider going registry at my primary employer.

Why don't I just go registry there in the first place, especially as they pay more?  I have to give up the flexibility because they have a stricter scheduling commitment.  Plus I can't get the experience there that I can get at this agency site, which is emergency crisis stabilization.

It is finished

The final paper grade is in...our group pulled off a miracle and bagged two 100s in a row:  the journal club and now this.  With these two grades, the rest of my group better have passed the class.

As for me, I knew I was going to pass...but including my quiz score, I now have the equivalent of bowling's turkey.  So I got my A.   Kolohe, guess you bet correctly.

I'm just glad I never have to take this course again.  I'll be burning my research notes shortly.

I'm supposed to restart at the agency this week, but my primary employer keeps giving me hours.  As my primary employer pays 1.5 times the hourly rate than the agency, guess who wins in the heads-up battle.  It's hard to say no to working 6 hours at one place and making more money than working 8 at the other.

Especially since now I'm paying more childcare costs.  I figured out that I have to work 4 shifts a month at either place to cover the monthly cost of little one #2's childcare--anything after that is profit.  And that I definitely need as July is the month that everything needs to be renewed:  ACLS, PALS, BLS, CPI, malpractice insurance and two professional organization memberships.  And I need a 90,000 mile tuneup on my truck.  And we're going on vacation next month for a few days.  And I have to pay childcare in advance.

Of course, some of these I can live without:  I can scratch PALS and the memberships and still be able to work.  In fact, I am thinking of ditching PALS as I'm not working in environments in which  children are my patients.  But everything else is a must-have.

Why the ACLS for a psych nurse?  For working in the psych ER.  As it is technically an ER, ACLS certification is needed.

Anyhow, so in my first couple of weeks back at work, I have made enough to cover June's childcare expenses and have leftover profit, which is good.  I'll see exactly how much when I get paid this week.

I'm also trying to keep it to two days a week total.  I figure if I do need to pull an extra day, it will be on a weekend so the better half can keep the little ones with him.  Ever since the better half figured out how to defrost breastmilk, my presence really isn't always needed.  As long as I keep doing the moo-cow thing and filling the bags.

Speaking of which, I'm glad I spent a couple of months practicing with the pump.  I've got it down to a 10 minute science with no stress or problem.  Plus, I hooked up with a doctor at my primary workplace who is also pumping, and she's offered me the use of her office fridge to store my stash.  Nice.

...or not

Or it may not be the Smashbox foundation...but the Smashbox primer that I received a sample of.   I realized that the reaction occurred after I tried the hydrating primer.  I tried wearing the foundation alone for a couple of days...no problems so far.  Which is good as I really like it and didn't want to have to return it and try to find something else that would cover the rosacea flare-ups.

Research class is finally over.  It was the roller-coaster up until the very end, but I have to admit, I learned a lot about research...and group dynamics.  I think once I adjusted my expectations of my group mates, it became a lot easier to work with them.  I had to accept that not everyone is going to attack the class the same way as I do, and that's OK.  Everyone's got their own motivations and mine are no better or worse than anyone else's.

The final paper was submitted today, and unless our paper is FUBAR and it fails, I will have that A after all.  What gave me a boost was that I got a 100 on two projects in a row:  a group project worth 20% of the grade and a quiz worth 15%.  Both were surprises, especially the project.  But the way this class has been, I won't celebrate just yet--let me wait for the final grade to come in.

No, I'm going to celebrate anyway.  Worst case scenario:  I have a B.  But more importantly...I am done with this class and never have to take it again.  That alone is worth celebrating many times over.

It was the Smashbox.  Two days without using it and the skin is almost perfectly smooth again.  Unfortunately, I've always been prone to post-inflammatory hyperpigmentation, so the redness will stay with me for quite a while.  Oh well.  Off to return my purchase.

Final week of Research class....quiz on Wednesday, final paper on Saturday.  I volunteered to take the lead on the final week in.  I feel confident that I will pass the class.  An A is still mathematically possible, but I'm not letting myself think about that, lest I get my hopes up:  I'm aiming for the B.

Back in the saddle

The first week of work went well.  I spent more time showing off pictures of little one #2 than anything.  I also promised to bring him to the next treatment team meeting so everyone could meet him. It was also a slow week due to a very low census, so there weren't any crises to deal with.  It was a nice  and gentle easing back into the routine.

Of course, being out for four months meant that many of my familiar patients have moved on...for now anyway.  Unfortunately with the high rate of recidivism in psych--especially in addictions--many will be back.  

A few things changed while I was gone...the cafeteria menu got a major overhaul.  I went in there with a few of my patients and was amazed.  Not only are there more choices, but the food's actually better than it was before.  It wasn't horrible in the first place--it was actually pretty good as far as hospitals go. But now they've taken their game to the next level.

It felt nice to be back at work...I did miss the sprog but I also missed being at the hospital.  

Speaking of which, little one #2 is having a blast at his daycare.  I knew I made the right choice every time I saw him at pickup time.  

I also let the agency scheduler know when I'll be available...either she has a fantastic memory or they're really desperate since a lot of people left the agency after they had to lower their hourly rates on a lot of the assignments.  But they were very happy to hear from me.  So I set up my end-of-June and July schedule there.  I expect to start receiving the "are you available" calls again soon.

In other news, I'm dealing with some allergic dermatitis on my face.  I guess Smashbox foundations don't sit well with my skin.  It's a shame too, because the color and coverage are flawless.  But I shouldn't be breaking out like a teenager...well, it's not that bad.   Mostly concealable with a beauty balm and one of the other foundations that I usually use, and it seems more like a reaction than a breakout as it's stinging and more red and diffuse, not raised in hard bumps.  Oh well.  

Since the Smashbox is the new kid in the lineup, I'm guessing it's that that caused the reaction on my face.  We'll see if the problems resolve in a few days.  Shame too...it took me forever to find the perfect shade.

Another Daily Mail comment in the top 10.  I know, this isn't much to all of you.  It isn't much of anything, really.  But it does amuse me.

It's funny though.  I'll come up with a well-thought out, long, substantial comment and it'll barely raise an eyebrow.  Then I'll plink out something on the fly and next thing I know, it's on the main page.

The forum I work at is like that too.  I can post something long, substantial and well-thought out, and get three Thanks tops.  Something on the fly or totally tongue-in-cheek, and there's 30 Thanks before I log off.  

There's no rhyme or reason why people Thank a post, I suppose.  I admit, I have no rhyme or reason as to why I do it.  Sometimes it's because I thought it's an excellent post.  Sometimes it's because there's only one thing in the post that I agree with.  Sometimes it's because I wanted to show support for the poster.  Sometimes what they wrote just caught me in the right way at the right time.  No logic, really.

Anyhow, tomorrow I go back to work.  Tying up the loose ends today:  making sure everything is square with childcare, getting the pump ready to travel, digging out the scrubs, making sure the work bag is ready to go...yes, still bittersweet.  Especially since little one #2 just got really fascinating all of a sudden.  He's constantly vocalizing and trying to move himself.  At least I know he'll be in great hands when I'm working.

The first couple of weeks are going to be hard but I'm sure I'll be able to transition back into it with few problems.  I hope.  No way to know until I actually do it.

I have decided that before I start any new knitting or crochet projects, I have to finish at least three of the projects that I have hanging around the house.  I have way too many works-in-progress and I can't just keep casting on new ones willy-nilly because I'm inspired at that particular moment, then drop the project for weeks/months/years because something else intrigued me.

So yesterday while out knitting with some friends, I finished one of these projects: a cotton washcloth that I started long before I moved to California.  It kind of fell through the cracks and I rediscovered it only recently.  It came out really well...so well that I was thinking I should make another one just like it.  And I had to stop myself from starting a new one.

There's a pair of socks that I should tackle next...OK, there's four or five pairs of socks in progress that I should tackle.  But this pair is almost done--I should just finish it off.

But first, homework.

Walgreens...hiring nurses?

You read that right.  Walgreens.  The drugstore Walgreens.  Not just a place to buy mascara, booze and Advil--now it's also a career options for RNs.

Apparently they are looking for people for "Nurse I" positions.  I learned about it from my daily Indeed.com job bulletin.  I was curious to see what Walgreens would want with a nurse, so I clicked on the link.

One year of nursing experience required (sorry, new grads).   As always, BSN preferred.  No mention of what compensation would be, though I imagine it's a pittance compared to the local hospitals.

The job description is your standard nursing job description, so there's no real indication of what said Nurse I might be doing.  However, three big clues lead me to believe it's home health:  home health or infusion experienced preferred, you must have your own transportation for visiting patients, and you must be willing to travel up to 100% of the time.

I didn't know Walgreens dabbled in home health.  Interesting.

Not my cup of tea, but it may be someone else's...so if you're interested, go to indeed.com and look it up.

In other news, I start back at my main job this week.  Still bittersweet about it.

I also need to call the agency and give them my availability.  I figure that I'll get through my first week back first, then I'll start the agency work again.

Reasons NOT to become a psych nurse

A while ago, I told you why to become a psych nurse...now here's the reasons why NOT to do it.

Note that these are not necessarily automatic exclusions.

You have psych issues.  If they're unresolved psych issues and you see being a psych nurse as a means of treatment or therapy, turn around now.   If your psych recovery is less than a year old, proceed with caution.  If you've got a good handle on your recovery, still proceed with caution.

Working in psych isn't going to cure you.  It's no substitute for doctor visits or therapy.  Nor does your having psych issues mean that you'd be a good psych nurse, no more than my having given birth twice means that I'd be a successful L&D nurse.   Keep in mind that just because you had a certain experience with mental illness doesn't mean a patient with the same diagnosis will have the exact same experience, or that your experience is right and theirs is flawed.

You have issues with people with psych issues.  You need empathy to be good at this job.  It doesn't mean you have to be a pushover, but you have to have more than a "suck it up and get over it, it's all in your head" mentality.  If you have issues with psych issues, no matter how hard you try to mask it, it's going to come across in every single patient interaction.

Psych patients have something in common with kids:   both groups pick up more from what you say and do than you may realize.

You won't use as many of your medical nursing skills.  Unless you work psych-medical or geri-psych, you will be starting far fewer IVs and Foleys, doing fewer blood draws, staring at far fewer cardiac monitors, doing less suctioning of trachs, doing less managing of drips, and performing fewer of all of those other fun tasks that are primarily medical in nature.  If IVs, drips, Foleys and tele monitors are the reasons you want to be a nurse in the first place, you may be rather disappointed in psych nursing.

Psych patients DO have medical issues, so you will be using more of that medical knowledge than you think.  And don't be too disheartened about not using the medical skill set, as those skills can be easily relearned...after all, you learned them from scratch in nursing school, didn't you?  And if you are truly worried about losing the medical skills or want to make sure you have maximum marketability while in psych, get a PRN job on a med-surg floor.

Remember, in no specialty are you losing your "nursing skills."  You are just utilizing different skill sets.  The skill set for psych is different, just as the skill set for L&D may not be the same as that used for med-surg.

You think it's less physically demanding.  What, you think its just the techs that get down and dirty in codes while you sit back behind the nurses' station?  If you're the nurse, it's YOU leading the charge of the light brigade.  Understand that a code in psych is rarely medical distress and more likely out of control or violent patient.  Refuse to participate in a code or run in the other direction--and you will lose both the respect and trust of your coworkers because we'll all know that we can't trust you to have our back in a crisis.

Being female/old/young is no excuse for not getting involved in a code.  If you are pregnant/disabled/injured, then you have an bona-fide excuse for not getting hands-on...but you damn well better be doing crowd control or drawing up the meds.

Mind you, if there's a weapon, all bets are off:  then you are allowed to run and take cover while someone dials 911.

And of course, there's the usual physical nursing tasks.  You didn't think they all went away, did you?

You think it's easier/less stressful than what you are doing now.  This is really relative:  depending on what you've come from and how you are naturally wired, it may be easier/less stressful...or it may not be.   But don't think that it's automatically easier because there are less tubes, wires and monitors involved.

Ever see seasoned nurses cry because of working in psych?  I have.

Hepatitis C.  It seems like every other psych patient has Hep C.  Hep A, Hep B and HIV are there too, and so are bedbugs and scabies.  But there are vaccines against Hep B, Hep A resolves itself with minimal problems in most patients, and HIV is a fragile virus that survives for less than a few minutes outside of its host.  Vermin can be treated with a good de-lousing.

Whereas Hep C is badass.  It can hang around on things for days.  Even dried blood can be an infection risk.  There's no vaccine for it either.  I fear that infectious disease far more than the others.

Of course, if you practice universal precautions you can drastically minimize the risk of exposure.  However, if you are of the extremely paranoid type, you may not be entirely comfortable with the high levels of Hep C...actually, that paranoia might not be a bad thing.  The hepatiti are not fun to contract.  Hep B and C are with you forever.  Hep A is at least curable.

And if you're a chronic needle sticker, for the love of Doritos, LEARN how to deal with a used needle and/or deal with any klutziness before entering psych.

Dealing with family members.  Unfortunately, family members of psych patients can often be far worse than the psych patients.  Many have misconceptions about psych illnesses.  Many don't understand psych meds. Many don't understand that psych patients, even involuntary ones, have rights including the right to refuse treatment, as well as the right to exclude family member involvement.  Many think we should keep psych patients locked up until they (the family) are satisfied.

Granted, you won't have to deal with family in person as much as you will over the phone, so if you have good telephone skills, you'll be OK.

You don't always get to wear scrubs.  A lot of psych jobs want you in "civilian" gear, so if you like wearing scrubs for either the comfort or the air of authority they give you, be prepared to part with them.  Civilian gear also usually means no street clothes (read:  jeans and sneakers) but business casual.

You'll become paranoid.  You'll get into the habit of pulling doors shut behind you and checking if they're locked, even in your own home.  You'll look at surroundings in terms of what regular household/hospital/office items here could be used as a weapons, and where the escape routes are.  You may even start checking your family members for cheeking.  I automatically flinch and assume a defense stance if you put anything in my face...unfortunately, little one #1 doesn't understand this yet.

Also, most psych patients look just like you and me.  You'll start wondering if anyone you know has been a psych patient.  And once you've seen what patients who are "just like you and me" are capable of experiencing,  you'll be a little less quick to think that they couldn't have psych problems just because they look "just like you and me"