December 20, 2015

In which Meriwhen says Yes...

to the psych-medical position.

I decided to withdraw my application from the ED for several reasons, a lot of which I won't go into here...let me just say that I didn't think I was ready for what I was going up against.  And that is true:  I do not have a lot of acute care medical nursing skills.  Maybe in a couple of years, after I get some more medical experience, I'll try again.

I will admit that after I withdrew, I felt at peace with the decision, like a weight was off of my chest.  Perhaps it wasn't meant to be right now.

So this brings me here, to psych-medical and the world's most painless interview:

Manager:  Hi.  Here's the scheduling requirements and the rest of the info.  Any questions?

Me:  No, it looks great.

Manager:  You start in two weeks.

The only reason that the interview was painless was that I had essentially been interviewing with them for the last year.  They've seen me and my work in action so they knew exactly what they were getting.  And I also knew what I was getting into, since I have been working shifts there for the last year.  The interview proper was to make sure I knew the specifics and agreed.

I was hugged by someone when they heard the news.  And I've seen a few excited that I was working my two-week notice.  Granted, I wasn't leaving at the end of two weeks, just becoming permanent staff.  I'll take this as they're happy to have me joining them.

I'll confess:  I was hoping that psych-medical would get back to me before I interviewed with the ED.  The manager got my official application the day after I interviewed fact, the ED manager called her to ask about me.  She was relieved when I had told her that I had withdrawn.

Financially, I'm going to be making roughly the same as I am now, which was a very pleasant surprise.  It actually will be a little less since I'm working just under full-time, but I also have the room to pick up an extra shift per pay period if I so chose.  Benefits (a lot of which I don't need and will decline), PTO, opportunities for growth and advancement, a great working was an offer I could not refuse.

I "start" after the New Year.

My mom is out here for the holidays.  It's weird not to have both parents here.  It hits me at odd times and in odd ways.  No one is going to provide running commentary and give me a hard time as I'm driving.

December 14, 2015

The ED Interview

I'm back home.  Still adjusting to a world in which my father isn't physically here's tough.

So let me tell you about my ED interview.

I had an interview for the ED training program today.  The interviewer was intrigued to see someone coming strictly from psych into emergency.  I explained that while I enjoyed psych immensely, I wanted a change; I wanted a position where I could do something different yet still use psych a lot, and the ED seemed to be a good transition.  I was asked the usual "how do you handle difficult..." questions, where I saw myself in 5 years, strengths and weaknesses, long-term goals...I thought I sold myself pretty well in that area.

My major strike against me is the fact that in terms of acute care medical skills, I don't have a lot of experience. So I told her about the ED nursing class I just took, my preceptorship (she knows my instructor, which is a plus amid the minus), and the fact that I learn and adapt quickly.  I can't say I was as confident about my sell in that area, but let's be real:  I can't (well, honestly, anyway) manufacture experience that I don't have.

She is going to call some references and let me know either way within a week or so.  So at least I will be put out of my misery quickly.

I have not yet heard back on the psych-medical application.

While I'm waiting, I need to weigh the positives and negatives of the position.

Positives:  new experience; diversification; gives me more career opportunities; challenging; opportunities for continuing education and cross-training; world's easiest commute; 3 12s means I can work or 2 days elsewhere.

Negatives:  salary decrease as I'm going from experienced in psych to novice in ED (though the night differential will mitigate some of that); steep learning curve; will not be able to work psych at the organization as it would be OT (I could still work psych elsewhere); won't be working with a great crew anymore; despite wanting a change, I'm nervous about leaving my comfort zone.

And another negative:  the other half is apprehensive.

I asked for his opinion...mind you, whatever that opinion is won't be the sole factor that determines whether I take the job.  But we're a partnership and his point of view does matter to me.

He feels that I have a lot of opportunities in psych and while is supportive of whatever I want to do with my career, he is worries about the learning curve and the finances.  He also thinks it's not a full-time job.  I attempted to explain--several times--that I would not take a position that would not be financially feasible, that it is in fact a full-time paying position albeit at a slightly smaller rate, and that with any change in specialty there is going to be some learning curve.

But he seems unconvinced.  In fact, I get the vibe from him that he rather I DIDN'T go for ED and instead stick with what I know at the better money.  But what he doesn't realize--and which I just realized and need to remind him of--is that I'm making good money because I'm a per-diem.  If I were to take a full-time job in psych, my rate would fact, I'd be making only $4 more than if I took the ED position.  It's the shift differentials that are going to help--hence why I'm only applying for nights.

Anyhow, the discussion descended into a tiff, so things are a little tense.


We'll just have to see what happens.  Of course, I may not even get the ED job and then there won't be any worries.

December 11, 2015

The day after

I did not sleep well all night.  I kept expecting to see him around, in the kitchen making a sandwich, in the living room watching television...

Today, my sister and I drove to the middle of New York State to take care of some business with Dad's side of the family, on behalf of Mom.  It went smoothly, then they wanted to go to the local pub to toast his memory.  Of course we wouldn't say No, so off we went.  His friends joined us, and we learned lots of new things about our father.  It was a nice distraction.

This was also the very first road trip that my sister and I ever took together.  We're so unalike that we never got around to doing these things because we had no interest.  We're so unalike that we had to laugh when the security guard at the hospital referred to us as The Twins when he called to our father's floor to authorize our visit.  She is a blue-eyed tan blonde, whereas I'm pale with dark hair and eyes.  He also couldn't tell which one of us was older, and we responded that we weren't telling.

For the record, it's me.

But the road trip with her went very well, and it was nice.  We really got to talk about a lot of things, including Dad.

In some nursing news, I got an interview for an ED training program that I applied to.  It was a long shot--not the longest shot, but I didn't think I'd be considered.   But consider me they did, so I go during the week to interview with the nurse manager.  I go straight from work to there, so I have to bring a change of clothing and some resumes.

December 10, 2015

And it's done

I slept all right, considering I was balled up in a recliner and woke up every time someone came into the room.  I let my mom and sister have the cot.  They needed it more than I did.  

Dad slept peacefully all night.  At one point, they had to clean him up and change his gown, but he didn't struggle with them as he usually did.  The night crew figured out on their own that I was a nurse...probably because the jacket that doubled as my blanket gave it away.   Plus I kept checking his peripheral pulses and looking at his vitals.

I woke for the day at 0600, went downstairs, had a birthday breakfast by myself.  Not the best breakfast, but it was protein.  And a large black coffee.  That was lifeblood.

Brought coffee up to the room.  Mom and my sister were up and they were getting washed up.  Then I went downstairs with my sister for more coffee, breakfast for her and mom, and a scone for me, because the breakfast really didn't cut it.  And more coffee.

We went upstairs, ate.   No change on him.  He didn't wake up.  His doctor hadn't arrived yet so we're just waiting.

My sister asked for some time alone with him.   She has really been having the hardest time of all...she was in denial.  She keeps thinking that my dad is going to either change his mind about hospice care, or make a miraculous recovery.  So I took my mother downstairs to let her have some fresh air and a cigarette.  She still smokes, and today I wasn't in any mood to lecture her about quitting.   

We sat outside for about 15 minutes, talking, sharing memories, wondering what was going to happen.  I told her that I wasn't upset about it being my birthday because today, he helped me arrived in this world, and that today, I was going to be there when he died.  It came full circle.  My mom said she never thought about it like that.

We're on the way back up when my sister texts:  Come upstairs now.   So we ran upstairs like bats out of hell.  I charged down the hall (dear nurses, I am sorry for plowing through the group of you but I hope you understand) and burst into the room.  The doctor--not his regular one--is assessing him.  My sister is hysterical and saying, "I think he's gone!"

So I check his pedal pulses.  I thought I felt a flicker, but then nothing.    My mom was touching his arm, and said she thought she felt something for a second.  

I looked at his face.  He was gone.

The doctor there called it.

He died before they unhooked all the machines and started the palliative care.  In fact, the doctor had talked to my sister and told her that they were going to get all the equipment to start the care shortly.   But my dad decided to die on his own terms and die quickly, instead of spending the day slowly fading as the treatment team would keep asking "do you want us to do this for him?" with every treatment.

My sister left the room.  She couldn't come back in it at all.

My mother left to comfort her.  So I had some time to talk to him...and I did.  I told him he just had to be stubborn until the very end.  I told him that I had two friends up there waiting up there with coffee and cigarettes, and he can hang with them until we get there.   I told him that I was sorry he wouldn't see little one #2 grow up.  I told him I was relieved that he was no longer suffering and at peace.  And I told him a few other things I don't want to share here.

All of the staff was very kind to us, and so many nurses, doctors, techs, everyone came by to pass on their sympathy.

My sister couldn't take it anymore, so we gave our final kisses and went to my mom's.  Mom needed some time for herself, so my sister and I went upstairs.  We toasted his memory with a glass of ale.   Fitting...and a little twisted since he was a recovering alcoholic.

My mother comes back, so we start making calls and messages to spread the word.  He did not want a service, so he's not getting one.  His wishes were straight cremation, with his ashes to be scattered in the ocean.   And we're doing just that.  Tomorrow, my sister and I have to go to upstate New York to take care of some things for my mom.

Family and friends have been calling and visiting, and we're sitting around drinking (me, coffee) and sharing funny memories of him.   It's nice to laugh and smile right now.

December 9, 2015

The final night...

My father's condition keeps deteriorating, and the decision was made for him to go on hospice care.  The nurses got him into a private room...I had originally thought it was the doctor who made this happen, but I learned that the nurses were the ones who did it.  Right now he's on a BIPAP and morphine IVP as needed.  Tomorrow, they plan to discontinue the BIPAP, start a morphine drop, and focus on comfort care.   Based on how he did with a trial run off the BIPAP, they expect death will happen fast.  The goal is to make it as smooth and painless as possible.

It sucks.  But he has no quality of life right now. And it's not going to get better.  Today, we told him it was OK and gave him permission to let go.

So we're camped with him in his private room.  My mother and sister are asleep.  I'm trying to stay awake and get the paperwork for the preceptorship done.  I'm also trying to stay awake for another 11 minutes because in 11 minutes, it will be my birthday and I'd like a few minutes to myself.   We didn't remind dad about that as we don't want him upset.  My mom is tore up about it as it is--she's convinced that the day will be ruined forever for me.  I told her it is something we have no control over and I would not want to be anywhere else but here with him right now, and that my birthday is very low on the priority list right now.

The nurses here have been fantastic.  They went above and beyond for him, and when they learned he was going on hospice care, they felt our pain too.  It was hard for me not to jump in and be a nurse instead of a family member.  They knew I was a nurse, albeit a psychiatric one.

And man, did I have to use every psychiatric nursing skill I had to get through this day.  My mother and sister are wrecks.  I am not...don't get me wrong.  I hurt a lot right now.  But I made a promise to myself that my father didn't need to see me in hysterics.  I have to reassure my mother and sister and keep them going.  And one of us has to stay calm enough to talk to the doctors and nurses.

December 7, 2015


My dad's condition has deteriorated.  My sister arrived and is going straight to the hospital.  I get in early afternoon tomorrow.  I wrestled with going today, but it's also the little one's birthday today, and I wanted his day to be special.  Birthdays are the world to a kid, and he didn't need to have his saddled with me leaving to see his grandfather who may or may not make it.

My birthday will definitely be while I'm out there, but after a certain point in life, birthdays are great but they also kind of just another day.  Last year I spent my birthday in a hospital too; sitting with little one #2 as we waited to see if he had a concussion.   

Right now, I'm not doing much other than waiting and trying to be optimistic.  My dad has beat the odds a lot of times, so I can only hope he pulls this long shot off.  I'm not doing very well, but I'm trying.

So let me talk about some nursing stuff for a bit.

My ED preceptorship ended...well, it would have ended tomorrow, but I had to truncate it because of the trip.  I discovered that a lot of the skills I learned in nursing school that I don't often perform in psych came back pretty quickly.  My assessment skills and ability to prioritize care has improved.  I'm starting to get the hang of starting IVs.  I've learned a bit about lab work and lab work interpretation.  The MDs here expect you to tell them what you think the patient needs, instead of you telling them about the patient and waiting for them to order everything, so I definitely needed to know a little bit of everything.

And I learned that even with a max ratio of 4:1 (it was usually 3:1), I was still running ragged trying to stay on top of things.  So while I've had great time management skills for an inpatient psychiatric nurse, they were lousy for an emergency department novice.

I have some paperwork to finish up for the class, so my computer is coming with me so I can do that. The last day of class is Saturday.

I decided that I liked emergency nursing enough to try for a position.  My main organization periodically offers ED training for nurses interested in switching specialties.  Usually they ask for 1-2 years of tele/stepdown/med-surg experience, but this most recent posting will take 6 months of acute care experience.  So I applied even though I don't have the 6 months yet.  In addition to telling them about the ED course, I stressed how my psych skills would be very handy in the ED, how I started working with psych-medical patients, and how I go to their ED to do psych assessments so they've probably seen me.   The program starts in January so I'll hear pretty fast either way.

I applied to the ED at the other organization I work at and gave them the same sell, with some modifications, of course.  No idea how long it'll take for me to hear back from them.

We'll see what happens.

I am also applying for a psych-medical position.  I started floating to one a couple of months ago and while it's not my absolute favorite (that is psych ICU), it's very educational and I'm liking it.  One of their staff left and I expressed interest in applying...interest that was received positively by the managers.  I had some questions about the schedule that I'm waiting for answers on before I put in the application.  I may try to do it tonight before I leave.

That's all I've applied to for now.  I am kind of hoping I'll hear back from one of the EDs before I applied to the psych-medical position, but on the other hand I can't string them along--they are short-staffed and need to fill that position.
I have my plane tickets.  More than I wanted to pay, but I am a horrible flyer, so the less hassles I have to deal with, the better.  So it's non-stop, which is good because as soon as I board a plane, into my mouth goes 1-2mg of alprazolam.  That, plus my white noise app to try to sleep through as much of the trip as possible, and I am usually fine.

Didn't break down at work, but everyone could tell something was up.

December 6, 2015

In which Meriwhen gets the call she's been dreading

It's about my dad.  He hasn't died yet, but he is not doing well at all.  His condition hasn't changed much, but he's very depressed, refusing to take his medications, and has lost the will to live.  My mother wants my sister and I to come out for a few days to cheer him up...but I think, in all honesty, it may be to say goodbye.

I knew this day would be coming.  I was hoping it wasn't going to come for a while longer.

I told the other half that I have to go no matter what.  He worries when I fly by myself, but he understands.  And even if he didn't, I'm still going.  I only have one father and I'm going to see him at least one more time.

So I've started looking up flights.  My sister can't only go over a weekend because she works during the week.  I can't go over a weekend because I work weekends.  I don't know what she will do, but I'm looking at flying out during this week or the next.  She's talking to my mom to find out when we should be there...better one of us at a time talk to her.

This means I may end up having to spend my birthday out in New York.

Meanwhile, I have to get ready to go to work.  My eyes are red and swollen because I couldn't help but cry a little, so this should make for a *fun* shift.

December 2, 2015

Almost done...

A couple of more days are left in my ED preceptorship.  During this time, I have learned that I know a lot, and yet I have a lot to learn.  I'd write more, but I'm too tired right now.

November 23, 2015

And I'm now .500 on IVs.  It infiltrated.

Oh well, the other nurse I was working with--yes, Virginia, I was not cancelled last night!--gave me a crash course in tricky dorsal hand vein sticks.

November 22, 2015

Cancelled again

Cancelled on a Saturday...a Saturday night, no less!  But I know the census has been down lately, and as a float pool per-diem I'm technically first on the chopping block--the only ones that can get cut before me are those requesting first cancel.  Staff going into OT are also technically supposed to be cut before me to, but they tend to let most of them stay.

So two nights lost.  I'm a little anxious but reminded myself that when designing the budget, I did prepare for things like this to happen.  I could lose up to 4, even 5 days in a month and we'd still be OK.  We'd have nothing going into savings that month, but all household expenses would be covered.

Mind you, I'd rather not lose the days in the first place.

So I called the charge nurse this morning and asked her what the likelihood of my being cancelled  on NOC was, and if it was high, could I work a PM shift instead?  She reassured me that I should be working NOC tonight.  Now whether that will really happen--after all, Friday was supposed to be guaranteed as I was swapping shifts to cover for a vacationing staff member, and I still got cancelled--I won't know until 2100 tonight, which is the deadline for me to be called off.

Should I get cancelled, I will go and make myself available for Monday PM shift.  Monday was going to be a day off as Tuesday is a clinical day.  But if I'm losing Sunday too, I need to make it up.  Even though that means I will get about 4 hours of sleep between work and clinical.

I may decide to put in for Monday anyway.  I am only scheduled to work 3 days this week because of my preceptorship and the Thanksgiving Day holiday, but since I lost 2 days last week, it may be a good idea to grab this extra day if it's available.  Though that means I'll have 4 hours of sleep between work shifts AND 4 hours of sleep between work and clinical.


The permanent job is looking better and better.  Fortunately, this ED preceptorship is finally happening so once this is finished I can start looking.

November 21, 2015

Ups and Downs

Up:  I have started a preceptorship in the an actual ED nurse.  Not as psych liaison, not as a psych nurse providing psych care to ED patients, but as an actual ED nurse.  I completed the ED course and this is the clinical component.  The school was able to place me in a hospital in my organization, so that helped tremendously, since I'm familiar with the EMR and how things work in general.

It was funny.  The nurses kept interrogating me about how the psych areas work.  I was happy to explain, since I think EDs in general don't understand how psych units work.  This is not a slur upon the ED, just that it is a different world.

Anyway, I'm two days in and so far so good.  I get a different preceptor each day and both have been fantastic.  I can only hope the next five will be too.

Down:  Cancelled again.  Which is unsettling as not only was I confirmed for work, I was specifically signed up to work to cover someone taking a day off.  So whether it's because the census is down, they found another nurse to cover, or the original person took the day off, I don't know.

Down:  And I hadn't worked earlier that day, so it was truly a zero hour day.

Up:  Financially, I'll be OK, I think.  This paycheck will have just under 64 hours, so I wonder what my take-home pay will be.  Hopefully not as bad as I think, and I have made provisions for such times when I might end up short in the pay department.

Down:  But you know I'm still anxious as hell about it.  I like some stability in my schedule.

Down:  Though the downside of stability in my schedule will be a pay cut.

Up:  Which may be worth it for the stable schedule's anxiolytic effects.

Up:  I started my first IV, and on my first try to!   77 year old man who was blessed with decent veins, all things given.  I admit, I was the most terrified about being able to do this, since coming into this, my record involving inserting needles in veins was 0 for 1.

Up:  I'm enjoying the ED so far.  Mind you, the first day was pretty slow, and on the second day my patients turned not to not be high acuity.  And I'm only dealing with 3 patients at a time (thank you, California ratio laws).  So I know this isn't necessarily representative of the norm.

Down:  I really need to review prioritization of needs.  ABC and Maslow are generally accurate, but there are times when something may take a bit of a higher priority to a C.  Like the possibility of brain attack.

Up:  I'm considering what I can do with my new skills once I finish the preceptorship.  Maybe ED, maybe Urgent Care, maybe full-time Psych-Medical.

Down:  I can't really make any moves until I finish this that means January.

Up and Down:  I learned that when you update your resume on a career website, even if you're not actively looking, recruiters come out of the woodwork.  Though not all jobs I'm being pitched are what I'm looking for.

November 13, 2015

"Although you have met the minimum requirements for the position, there are several other applicants who have qualifications, experience, and other relevant background that more closely fit the profile of the available position."

The e-mail arrived. I am a little disappointed, of course...but if I look at myself, my career and my skills, I suppose they are right. I am coming from a nursing area that really doesn't have a lot of--for lack of better phrasing--medical skills. It's not as though I'm a L&D or LTAC nurse switching over.

It's times like this that make me consider whether I should pursue a full-time psych-medical position. 

Oh well. I'm home tonight thanks to a last-minute cancellation at work. At least I get 2 hours of pay so it's not an entire loss.

November 10, 2015

Strike 2

I was rejected for the 2nd new specialty position.  I haven't yet received the e-mail telling me why, but I'm sure it'll be here soon.  Oh well.  At least they didn't leave me hanging for weeks about it...just one week.

I don't know if I'll give it a third try, as there's another position up.  Or maybe I'll apply for one of the psych openings instead.

Or maybe not.  I've secured enough hours at my main job until 2016, and my preceptorship is finally taking place.  So maybe I'll get through both of those and then see what happens.

November 3, 2015

Try, try again

Another new specialty position was posted, and I applied for it.  Fortunately, their system lets me copy my most recent application, so I did just that, tweaked it to reflect the current posting, and fired away.  I think I may be a little late--it looked like the closing date was 11/2 and today is 11/3...but what have I got to lose by trying?   I did make a note on my calendar to check that organization's website weekly, so maybe I'll hit a posting on time.

There were also a few behavioral health postings there, but I'm going to wait and see what happens with this one.  I'm also not going to apply for anything behavioral health until January.

The psych liaison position is very interesting.  I had a good orientation, learned a lot about doing intake, and am now certified to place people on psychiatric holds...well, only at that facility, anyway.  I'm not allowed to go to the local Wal-Mart and wield my new powers, no matter how much they may be needed.  Anyhow, I haven't had a chance to pick up any more liaison shifts there just yet because my schedule from now to December 31st is a mess.  Going to try though.

I totally forgot about the Spanish class...I have until 11/19 to finish it though, so I think I'm going to cram as much as I can, then download whatever I can so I have it for the future.  I also have to start brushing up on the emergency department stuff, as the preceptorship finally has a start date of 11/18.

October 15, 2015

Dear Meriwhen,

Thank you for your interest in the position.  Unfortunately, the position has been cancelled.


Better than being rejected,  I guess.

September 30, 2015

My application status for the new specialty position remains unchanged.

Meanwhile, I've been rooting around my primary organization to see what opportunities they can offer me.  Truth be told, I'd rather not leave fact, I'd like this to be my permanent home.  That is, if I can find a position that is financially feasible and professionally satisfying.  My second choice is to find a permanent position elsewhere that is 3 days a week, and then pick up 2 days as a per-diem here.

So here at my primary organization...

I'm being wooed to go permanent at the temporary position I'm working, or at least transfer to being a per-diem there.  I would, except that it's outpatient.  I really want to go back inpatient, plus I don't get shift differentials for outpatient so financially, it would be tight.  There's also no guarantee of 40 hours...mind you, I could probably pick up a few inpatient shifts here and there.   But I also don't really want to work 6 or even all 7 days a week.

I'm also being wooed to go evenings inpatient.  While I love evening shift, it's very hard to work them with a school-age little one.  Full-time evenings means I'd almost never see him during the week.  So while this isn't a top choice, it's a good safety net, especially since evening shift is the hardest of all to staff:  there's plenty of availability.

I started picking up several inpatient shifts at the medical hospital, mostly nights and the odd evening.  Of all the facilities my organization has, I like this one the best.  I'm patiently waiting for a night position to open up there.  Or an evening/night mix.

I've been offered the opportunity to orient as a liaison in the emergency department  I'll get to evaluate ED patients to see if they meet criteria for psychiatric holds and/or admission.  That starts in a couple of weeks, so I'm going to see what particular things I should brush up on.  My having taken that emergency nursing class will also be a help here, as I'll know more about whether they are medically stable enough for the psych unit.

September 24, 2015

It kind of reminds me of the new grad job search...only with less desperation

"Your application has been forwarded to the hiring manager for this position. Upon review, if you are determined to be a good match, the hiring manager for this position may contact you directly (by email or phone) to schedule a phone interview and/or an on-site interview. Depending upon the department, this process may take several weeks."

At least I'm checking the hospital's career website only daily, instead of multiple times a day like I was when I was on the new grad job hunt.  It does help that I'm several years' more experienced in both nursing and job hunting, and I know and understand that the wheels of HR turn slow.  And it helps that I am currently working, because there's less of a desperate push to jump at anything that I get.

The wording of the above message hasn't changed at all.  Some things just don't change.

September 22, 2015

The saga begins...

I applied for a permanent position.  It was not at any of my current facilities, but an entirely different facility.  And I didn't apply for a psych position, but instead for a new specialty training program.  The training would be in med-surg and tele.  It's 3 12s, which would let me keep my position at Job #1 a per-diem basis.  It's also nights, which is perfect.

So I brushed up the resume, wrote a great cover letter, and applied online.

I don't know what my chances are...apparently the position has been up for a while, so who knows if there are multiple positions, if it/they have been filled already, or if it's just a resume collector.  It's also a union facility, so internal hires get first dibs.  Still, I did get into a hardcore union facility'll just be tougher this time as I don't have anyone on the inside to vouch for me.

We'll see what happens.

Meanwhile, I signed up for a Spanish for Healthcare Providers class.  Lately I've been assigned to a Spanish-speaking patient.  Surprisingly, I manage all right:  I can't really speak Spanish, and I don't understand every word the patient says, but I catch enough of them to have an idea of what's going on...some of the time.

September 17, 2015

Like like

Not to be confused with the Legend of Zelda enemy that eats your Hyrule shield.

When a psychiatric patient likes you, there's one or more reasons behind it:

They truly like you, no strings attached.  Sometimes the blue box is blue.

They truly like you, no strings attached...for right now.  They may have bipolar or borderline personality disorder, and at this moment in time, they really and truly like you.  But something happens, and suddenly you're Public Enemy #1.   It may be something you deliberately did, something you did without meaning to...or maybe you did nothing whatsoever.  Or it may be something entirely on their end.

They're flirting with you.  Be sure to set and enforce boundaries for all parties--including you--to adhere to.

Transference.  You remind them of someone else that they think fondly of.   It may not necessarily be a physical resemblance that triggers it.

You gave/did something that they wanted or which helped them.  Self-explanatory and possibly fleeting.  Mind you, this doesn't mean they're a bad or manipulative person.  Keep in mind that being in a hospital is stressful enough, and in a psychiatric hospital doubly so.  Try to ease the stress for them when you can.

They're trying to manipulate you.  It may be a patient engaged in staff splitting, especially if they're bad mouthing someone else at the same time they're lauding you.  Or perhaps it's a patient with antisocial or another personality disorder using their charm to further their agenda.  While you may develop a rapport with specific patients, don't fall into the trap of "I'm the only one that understands them!" because patients, especially the ones with personality disorders, will work that to their advantage.

Their pain is relieved.  Pain can really bring out the worst in people, and relieving it can bring forth a lot of warm feelings.  I never understood why new mothers say they wanted to kiss their anesthesiologist until I had one start the epidural during my own labor.

The PRNs are kicking in.  A B52 (Benadryl 50mg, Haldol 5mg, Ativan 2mg), or even individual parts of it, do a lot to take the edge off of a patient.

I have a patient who falls squarely into category 2 (with a hint of 8).  They have a history of falling in and out of like with me.  The most recent shift started out with them throwing things at me (we had parted on good terms the last shift).  One PRN and an hour later, I was their best buddy for the next several hours.  Then I don't know what happened, but once again I was on their hit list and dodging items.

September 10, 2015


I don't usually directly link to or even really discuss on my blog, as I prefer to keep my writing here separate from my moderator work on the forum., the two worlds will converge.

I...well, all of us, have been blindsided by this.  I couldn't believe when I saw this in the news and I went to the forum hoping that it was a horrible mistake or a bad joke gone wrong.   Not much is known at this time other than five lives have been lost.

I am honored to have known Brian and to have been part of his team at the forum.   He was a good guy and I'll always remember how cheerful he was at NTI this past May.

September 3, 2015


Still working 5-6 days a week.  Mind you, I'm in two jobs that I both love, so it's not as torturous as it sounds.  But 5-6 days of work a week including a few NOCs in there...and time just seems to fly by.

I started researching online MSN programs.  I decided that I want to get started on my degree in the next year or so.  I'm not going to go for the PMHNP just yet because a.  the cost and b. finding an accredited program that is affordable.  I do live near a school with one of the best PMHNP programs around...but its also extremely expensive.  I spoke to someone who has just completed a PMHNP program and she recommended that since the DNP requirement is (apparently) becoming a reality in 2017, that I get the MSN now and then complete a post-grad/DNP program later.  She pointed out that I'm going to have to do the MSN-level work anyway, so why not do it at a school that is more affordable.

So I'm going to get a MSN in Nursing Education first.

I want to take an online program because of the flexibility, especially with rotating shifts and two little ones.  I have narrowed it down to three schools.  Benedictine, Sacred Heart, and University of Texas at Arlington.  All cost around the same, all are rather flexible, all have great reputations so far, though I'm going to do a little more digging.

UTA has the advantage of the easiest admission:  as I'm already a graduate from UTA, I don't have to submit resumes, transcripts, etc.  or take any admissions testing.  I pretty much have to tell them, "hey, I want in" and I'll be in.

In other news, my little ones are now addicted to Shaun the Sheep...more proof that they are indeed my children.

July 20, 2015

I know, it's been a while...been working a lot...really, A LOT.  Usually 5-6 days a week, mostly days and NOCs.  Once the other half retires, I think I'm going to go straight NOC.  I enjoy it.

Will post more when I'm more awake.

May 14, 2015

So I joined the social media forefront

Well, not really.  I just added a Twitter account to this place.  Of course, it's @meriwhen.

Mind you, this isn't my first Twitter account.  My original Twitter account is circa 2007, in use before Twitter even got on the map.  I also have an account for professional reasons.  Then there's this one.

You're welcome to follow me, but don't hold me to high entertainment standards.  More than likely it'll be random thoughts, promoting forum threads, and re-tweets of things I found interesting.  I've seen how dangerous social media can be to one's career and reputation, and I have no desire to kill either of mine by a careless choice of words.  So I plan keep things relatively innocuous there, like I do here on this blog.

The Internet is full of the news articles about people getting fired or raked over the coals for something they posted on Facebook/Twitter/Blogger/et al.  They posted something they shouldn't have, or they posted a bad/tasteless joke, or an inflammatory remark, or something racially/religiously/politically charged, or shared way too much information.  Perhaps it was even something that they thought would be funny or interesting, but the universe thought otherwise.   Whenever I think of Internet missteps, I always think of that nursing student who posted the picture of the placenta.  I wonder what ever became of her.

I recommend reading So You've Been Publicly Shamed by Jon Ronson.  It's a very interesting read about how easy social media makes it to call someone out on something they did:  you can name and shame them in about 10 seconds...and anonymously, no less.  And the Internet being the Internet, once something is posted on it, it's out there forever.  Even if it's taken down right away, it's very possible that it's already been crawled, cached, copied or (screen)capped.

There's several case studies in there about actual people who have been publicly chastised.   It's amazing the damage that social media can do to a person and their reputation,  how fast that damage can happen, and how out of control the stone-throwing can get.  They don't call it a Twitter lynch mob for nothing.
What isn't in Ronson's book--but is a very interesting follow-up story--is that one of the people who called out someone for a rather tasteless tweet (her story is in the book) was in turn shamed for something HE posted.  He make a joke about bullying that backfired on him; he couldn't believe that people would think he was condoning bullying.  But they did...

Of course, he now has quite a bit more sympathy for the woman who he helped bring down.  Funny how being on the wrong end of the bulls-eye will do that to you.

All of this will make you think twice before you post anything online.

In other news, I found a PALS class and registered for it.   I've got just over three weeks to brush up on pediatric codes

May 10, 2015

I'm entering the final week of my assignment with Job #3.  When I started I thought I would struggle because it was so long since I had worked there (6 months!), but I found that it came back to me pretty quickly.  It's also a nice change not to wear scrubs to work...though I'm ready to get back to them.  I only have two pairs of dress pants so I have to do laundry frequently.  And I can't wear skirts because of the tattoos on my legs, which would take quite a bit of Dermablend to cover them up.

After this is the nursing convention which I am working at.  I didn't schedule any work for most of that week, so even though I'll be "working" for the forum, I won't have to work.  Then after that my schedule is rather light until the middle of June.  I kept it intentionally so since I have to renew BLS, ACLS, CPI and a bunch of other things.  Plus do some things around the house before I begin my summer assignment at Job #1.

Then there's the ED preceptorship, though it may not happen right away.  I finished part 2 of the ED course and wrote the school saying that I would like to do the preceptorship.  The instructor, the school and I are trying to negotiate when this can happen.  We're aiming to do it at Job #1 (the instructor happens to work for the same healthcare organization as I).  I had told them that either mid-May to Mid-June, or I'd have to wait until October after this assignment.  I'm thinking it'll probably be October, since it takes time for my organization to get things processed.  Plus in October, I'll have a lot more freedom in the days and shifts I can work.

So in the meantime, I'm getting all of the paperwork and requirements completed.  I may have to take PALS...I think I'll try to do that before the summer.  I took it once before but I had let it lapse, so it won't be entirely foreign territory.

In the meantime, I started working out regularly.  I actually started on April 1.  I've been doing a workout DVD about every other day.  I don't think I look any different, but I do feel better overall.  And on day #1, I couldn't get through the workout without stopping every few seconds--now my endurance has increased to the point that it's rare if I pause.

I also started paying closer attention to what I'm eating because I didn't like my most recent GFR.  Yes, I know that a GFR measurement alone does not indicate kidney disease...and fortunately, all of my other levels were fine.  But I did have the preecplampsia and then post-partum preeclampsia from my pregnancy with littler one, and since then my GFRs have been below normal.  This one is the lowest yet.  Also, my blood pressure still requires a med to keep it under control, and I could still stand to lose weight.   So let me act on a potential problem now before it becomes an actual one.

April 18, 2015


I've had a rash of patients with bipolar disorder that are in mania.   I don't know if it's something in the water or the alignment of the planets or whatever.   Usually, I get them on the downside--they're depressed--so to see them dancing as fast as they can takes some getting used to.

Dealing with manic patients can wear anyone out.  They're talking a mile a minute, they're constantly fidgeting and restless, they're impulsive and unpredictable, they bounce from topic to topic as they follow their flight of ideas, and they're so distractable that they need constant redirection.  Then it gets even more fun if they're delusional on top of that--the grandiosity, the ideas of reference...

I feel like I've run a marathon after admitting such a patient.  I ran a lot of marathons lately.

Most want help stabilizing their mood.  The occasional one prefers their mania and would rather stay in that state.  I don't judge, I just make sure they stay safe and out of trouble.

Of course, it's always entertaining when two patients in mania meet.  They can keep each other entertained rather well because they can keep up with each other.  I'll have them hang out near me and let the two of  them have at it.  I just have to make sure that neither one (or both) are hypersexual, lest I have to go break up a romance or worse.  But anyhow, the conversations they have can be fascinating, though a little exhausting to listen to, especially if they try to pull me in.

Or I'll have them help me on the floor.  They're great at folding laundry...heck, they're happy to have something to do to burn up all that energy.  Occasionally I'll ask if they can tidy up the unit, which they're happy to.

Hopefully when I return to work, things will have calmed down.  I'm savoring this weekend off because I'm not going to have a lot of weekends off for a while.  Thanks to having to balance the scheduling demands of Jobs 1 and 3, I am working at least one day of the weekend every weekend for the next several weeks.  I did manage to save Mother's Day weekend for myself though.

April 12, 2015

Long time no type

So let me bring you up to speed.

I'm in demand at work:  a lot of staff have been going out on leave of absences or taking vacations, so I've been racking up days left and right.  Most weeks I have 5 days booked; some weeks I end up with 6 days. I have to be careful not to hit OT though because while I'm in demand, they're not desperate enough to want to pay me OT.

I accepted one potentially long-term assignment, which turned out to only be a couple of months because the nurse I was covering for returned from leave early.  So they were thinking about shifting me to another long-term assignment but they only wanted to book me for a month or two at a time...which meant that when another unit requested me for a long-term assignment coming up this summer, I was available for it and said Yes.

The first unit is now kicking themselves because they had blown their chance.  The second unit is trying to adopt me.  I have a guaranteed assignment starting in mid-June through October, with the potential to continue on to a very long-term part-time assignment past that.

I admit, I am intrigued because of all the units I work on, it's one of my favorites.  But then again, I'm still deciding if I want to accept a permanent position by the fall and if I do, there's a chance I won't be able to work this.

I'm now kind of torn about getting any permanent position.  On one hand, I want the stability.  On the other hand, it'd be a major pay cut and loss of flexibility.  Right now I'm getting enough work to make staying float pool a real possibility...but it wasn't but a few months ago that things were on the famine side.  *sigh*

I'm still working inpatient NOCs at the hospital in town.  I find that I'm liking it very much, and they're liking me very much too.  The shift isn't too bad as far as family life goes either, because they're 8 hour NOCs, not 12s.   Going NOC, either as permanent staff or float pool, is also a real possibility.

And that sums up Job 1.

Job #3 remembered I existed and wants me for three weeks.  I said Yes, of course.   While Job #3 isn't quite my favorite (not enough patient interaction for my taste), I am in Job #3's system which is a very hard healthcare system to crack into.  So I will do whatever it takes to stay in it and maximize my career options.

Job 2...well, I think that's come to an end, though I haven't officially broken up with my agency.  I should do that this week.  I don't want to sever all times, but I do want to let them know that I'm off the market for now and maybe may return in the future.

I got sick.  Laryngitis.  Whee.  And I had to be coordinating nurse on the unit that NOC shift...which was fine until it was time for me to tape report.

The littler one also got sick with a stomach bug.  Not so whee as the child can vomit like the world is ending.  Seriously, he would wake up out of a sound sleep, yack, roll over and go back to sleep.   I had to call out of work for several days.

And then I got sick again...well, not sick sick.  But constantly tired, itchy, rashes on my arms, losing some more hair than I go to the doctor tomorrow for an evaluation.

Part 2 of the ER nursing class went well.  It would hectic and tough, but I got my A-.  I'm looking at when to schedule the preceptorship.

I ran a half-marathon.  Well, walked/ran.   It wasn't my best time but I finished it...and this year, I got a finisher's medal!  I already registered for next year's version.

I went on vacation to see my closest friend and her family.  I got another tattoo while I was there.

And then NTI is coming up.  I will be there in a working capacity for the forum, so if you're going and want to see what a Meriwhen looks like, here is your chance.   However, it's on you to figure out which one there is me.

Busy indeed.

I'm enjoying this weekend off because next month I won't have a single weekend free:  because of the scheduling requirements for Job 1 and the fact that Job 3 is strictly Monday-Friday, I had to put in for several weekend shifts just to meet my required availability.   The joys of per-diem life...

March 3, 2015

Very very busy lately.  I've been covering a lot at one site and pulling some NOCs at another...this is all for job #1.  Jobs #2 and 3 I haven't been at in quite a while...I think it's going to be time to finally part ways with Job #2, though on the most amicable terms possible.  Job #3 is per-diem so I'm just staying active enough to remain in their system.

NOCs are growing on me.  NOCs in psych are fun.  Enough patients are awake to keep it interesting, administration is out of our hair, and the hours fly by.

I think the NOC site is wooing me.

I asked for a set of keys:  I got two.  I asked if they could sign off on one of my competencies, and they gave me a whole stack more to complete that were just for them.  The last time I was there, I found they made me a mailbox.  Today, I learned they started including me on their staff lists.

I admit, my head is turned.

But I have a few more months to decide where I want to land.  I'm still finishing up the emergency nursing class, and then I have the preceptorship.  After that, I'm going to go to Job #3 to see if I can land a position in that area, either ER or urgent care.  Then I'll do that 3 days a week and keep Job #1 for 2 days a week.

January 17, 2015

I think I could do NOCs

NOC #1.  I was on the open units.  Great group of nurses, interesting mix of patients.  Actually got to see the supervisor/charge nurse in action on the units all night instead of them holing up somewhere...I like that.  The routine at this facility is different than what I'm used to at my regular facility, but not drastically.  Still, those little quirks will take some getting used to.

It was peaceful (not always a bad thing in psych), but there was enough to do that I wasn't bored.  In fact, the first four hours flew by--before I knew it, it was 0300 and I was told to go to lunch.  Around 0500, I started struggling in the staying-AOx4 department, but revived by going out for some fresh air.

I was home before 0800, though not in bed until nearly 0900...that was because two little ones were excited to see me when I got home, so they needed some love and attention.  I slept until 1400, then took nap this evening.  I'm feeling pretty good about doing it all again tonight.  I'll be on the locked units, so there promises to be some excitement.

January 16, 2015

Well, I made it to 0300...kinda sorta.  I dozed on and off, in between catching up on music videos on the On Demand service.  I had to get up at 0600 to get the little ones off for the day, so I'm feeling semi-groggy right now.

On an semi-related note, I finally got to hear what Iggy Azalea sounds like.   She's good.

I'm going to go for a run in a bit, then get more sleep later this afternoon.  I'm not too worried about being able to stay awake...I know that once I'm on the job I can do it.  But there is also a difference between being awake and being coherent, and I want to be the latter.

January 15, 2015

Usually, most nurses have to do this during their first year, but I like to do things differently

NOC.  Tomorrow is my first NOC shift ever...well, ever as a nurse.  It only took me several years to get here.

You know that informal interview I had earlier this week?  Well, they liked me enough to decide I'm worth training and are going to spring for the training .  They talked to my manager, who authorized the crisis management course I'll have to take and will pick up that cost.  I'm being invested's a nice feeling.

I train this weekend, and if they're satisfied with my performance, I'll be able to pick up NOCs there whenever I want.  There's a few psych units with a nice mix of populations, including that psych-medical unit that I've been trying to get on for a few years now.   I won't get to choose where I go--I'll be sent wherever I'm needed...which is perfectly fine with me.  It's just nice to have a new location to get work at.

So I need to get myself into the NOC time-mindset...guess I'll be staying up a little later than usual tonight.

January 12, 2015

Wish me luck

I have an informal interview with a nurse manager at the hospital in town.  Informal in that I'm already an employee of the organization, she knows I'm part of our float pool, and she wants to meet me to see if I'm worth training for floating over to the psych units at her facility.   Actually, I think I may have already met her three years ago when I wasn't an employee and first interviewed there...or I was supposed to going to meet her but the hospital was no longer interested in me.  I can't recall.  But let's see what happens.

I treat any encounter such as this very seriously because you never know what may come of it.   So out comes the dress slacks, portfolio and updated resume.  

January 3, 2015

And the famine continues...

Low census means I'm cancelled this entire weekend.  *sigh*

Oh well.  On the brighter side, it's a nice weekend to get outside with the little ones and my nephews.

January 1, 2015

Happy New Year!

Long time no's been pretty darn busy around here.  Not all of it has been work fact, I've been cancelled for most of this past holiday season due to low census.  I wonder if I'll even be cancelled today.  I know, it doesn't seem likely--after all, it is a holiday.  Then again, it wasn't too long ago that I was cancelled on a Sunday.  And it being a holiday does mean time and a half pay, and I'm sure there's lot of permanent staff that would like that.  I'll know by 1300 if I'm working or not.

So let me catch you up on everything since the last post.

November was full of lots of work at my main job.  Job #2...I haven't  been to and I'm not sure if I'll be going back there anytime soon.  They're a good agency and I do like where they send me, but it's a significant pay cut to work for them, so my efforts have been pushed at jobs #1 and 3.

Job #3...picking up a few days here and there.  They're debating about going on strike in a couple of months so I've been a little wary.  I've no intention of being a scab, but at the same time, I'd feel bad if we went on strike on one of the days I was scheduled to work for them, so I've been hesitant to be available for them.  I discussed my concerns with one of the staff nurses, and she said that I should just schedule myself whenever I want, and if it turns out that I'm scheduled on a day we're striking to just not show up to work, especially as they wouldn't let me in to work anyway.  OK.

I finished the first ER nursing class.  I learned a lot.  I got to put some of it into practice as at work, we've had to send a few patients to the ER.  And I got to see it in action from the patient POV as I had to take one of the little ones in.  He turned out to be fine.  The class helped me understand a lot of how the ER works, so I had more patience than I might have had otherwise...but it still was a long night for me.

December's work schedule has been skimpier because the census has begun it's annual holiday drop.  As I mentioned earlier, I got cancelled for a lot of the holiday season.  One of the unit managers felt horrible about having to cancel me--really, it was so sweet.  He wrote this long rambling e-mail about how I was valued and how he was happy to have me working on his unit any time...I told him not to worry, I know how things work d/t census so I don't take it personally.  I also mentioned the family coming in and that the cancellation would be a blessing in disguise.

The littler one and I both caught the stomach bug that has been going around.  Projectile vomiting is not fun at all, neither as the one vomiting nor the one being vomited on.  

I am now one year older.  Happy birthday to me!

Holidays.  Shopping.  Family in from the East.  Prepping for all of this took up most of December.  Then they arrived for two weeks...getting cancelled was indeed a blessing as we ran all around town for those two weeks.

I gained a few pounds despite my best efforts.  All that good food...

Last night, I didn't even make it awake until midnight.  Oh well.  I'm at the age where it's not the big deal it used to be.

So today.  New day, new year.  I generally try not to make "will/won't" resolutions but instead come up with some goals that I'd like to accomplish.  I think resolutions are too narrow and don't allow room for human error, whereas goals are more forgiving and I feel less horrible if I stumble along the way.

Though I did take on one spur-of-the-moment challenge.  I signed up for Dryathalon.  I figure that it's for good causes:  sponsoring cancer research, jump-starting weight loss, and giving my hepatic system some time off.   I'm putting my money where my mouth is to help keep me on track...and if family/friends want to support the cause as well, that'd be great.

The last time I gave up alcohol for something, it was for Lent and I ended up pregnant.  At least this time, pregnancy is an impossibility.