June 29, 2013

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.


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.


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.

June 26, 2013

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.

June 25, 2013

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.

June 23, 2013

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.

June 22, 2013

...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.

June 16, 2013

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.

June 15, 2013

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.

June 12, 2013

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.

June 11, 2013

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.

June 10, 2013

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.

June 9, 2013

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"

June 8, 2013

Going back down


I hate statistics.

I'm reading and rereading the chapter on statistics and I swear this chapter is not written in English.

This a research class, not a statistics class.

I served my time in research class in 2010.

Thank God that we don't actually have to run the statistics on anything, so that's a good thing.

But we have to understand them enough to be able to talk about them.

And with the way things are written, no on in my group can understand them.

And they're all kind of looking to me to understand them and explain it to them, since I've already explained a lot of stuff to them.

But I can't because even I don't fecking understand it.

Studying Welsh was easier than this.  

I should go back to studying Welsh.  

I can watch Pobol y Cwm and actually understand (without needing subtitles) it if I study Welsh.

And that is more entertaining than trying to explain what Cronbach alpha is.

But knowing Welsh in California won't exactly land me a nursing job at a magnet facility.

Having the BSN will.

So it's back to the statistics.


June 5, 2013

My maternity leave ends in 8 days.  Well, the official ending date was last week, but I go back to work next week on a part-time basis.


Happy and sad about this.  Happy to be back in the action; sad because I have to be away from little one #2.  But I can't have it both ways.

The Research Roller Coaster continues...

We got the assignment grades back.  We did pretty well on one of them and not so well--but passing--on the other.   The pretty-well one was a serious chunk of our final grade, so that's good news.  The not-so-well one still has one more part to complete before that becomes the largest part of our grade.  I think we can pull off something in the 80s, which will be nice.

Then I took the quiz...no, I didn't take it at 0300 as I feared I would have to.  I was going to wait until the better half came home to tend to little one #2, but I decided that I didn't want to lose a whole day doing nothing.  I wasn't studying because I felt if I didn't know it by now I wasn't going to know it, and I certainly wasn't getting any other work done because I was focused on the quiz...and trying not to throw up.

When I'm anxious, I get nauseous.  When I'm really anxious, I actually vomit.

Little one #2 seemed placid this morning, and I figured we may as well give it a try.  So I moved everything--baby, laptop, cable modem--into the nursery, set him in his crib, set myself up in the corner, said a prayer, and went at it.  Worst case scenario:  he flips out, I attach him to a boob while still answering questions.  It wouldn't be the first time I've taken a test with a nursing child.

He did a lot better than I thought.  I did a lot better than I thought...so well that I'm actually kind of shell-shocked.  No, not a 100%--I think I would have had a MI if that happened--but very close.

THEN I threw up.

So now things are looking up again.

Off to tackle the next assignment, which is the last part that I mentioned above.