Puttering along

Two days off in a row is nice.  OK, I am the first to admit that my current schedule is 97% my doing, and if there's anyone to blame for not getting two consecutive days off, it's myself.  But a shift swap at my director's request has resulted in the last two days being free, so I've been catching up on sleep (well, trying to), reading some non-nursing books and cleaning a bit here and there.

I'm not usually a fan of "chick lit", but for some reason I've been inspired to read them lately.  The nice thing about them is that they're fast reads:  for example, I went through Confessions of a Shopaholic in about three hours, and I'll probably read The Devil Wears Prada and At The King's Summons at the same rate.  I'm also on an Amish tear, so I've been reading a few factual books about their society.  Don't ask me why or how I get into certain subjects that I feel compelled to read up as much as I can on them.  I'm not sure how it works myself.

I've been on the detox unit for a few straight days, which is helpful as I get to be able to put faces to names as well as to their conditions, and I can see the progress or lack thereof over time.   Mind you, the variety of going to other units is nice too, especially since detox can be such a hectic place--with the exception of the intensive care unit, the other units generally tend to run less intense as far as meds and paperwork goes.  On the up side, the atmosphere is a bit more smooth on detox, at least I think it is.  They're all walkie-talkies, there's minimal psychosis, and the days are far more structured.  It has its moments, true...so do all of them.

So the new fridge is great--it actually keeps food cold.  Next paycheck will go towards new towels and sheets.  We've decided that whatever is left over from my check after all bills and expenses are covered should go towards doing things around or getting things for the house.  You know, the stuff that we keep saying we'll do but never get around to doing because of time and/or cost, such as window screens, getting rid of ratty towels, fixing the AC, etc.

The endocrinologist drew blood for more specific thyroid tests.  I should know something in a week...at least I've started losing some more weight though.  I'm down nearly 6 lbs since starting Weight Watchers.  The only problem:  I forget to eat while at work...which is actually not a good thing.

Tolerance and help

It amazes me what the human body can tolerate, and how much tolerance that the body can build towards something.   I admitted two patients who if going by the numbers, should have been comatose at the least, if not dead.  But both were walkie-talkies and in decent condition given what drugs they were on.  Both were also cooperative, though assessing them was a test of my patience.

They threw me up as charge nurse the other night, with only partial help with the medications.  I think I rose to the challenge well--I stayed calm, did everything the best I could, and I did the most important thing:  I called for help when I needed it.  And boy, I did need help during that last hour with the admissions.  I know I missed a few things on one of them, but the following nurse was going to go over the chart, and I told her I'd come in tomorrow to make sure everything was all squared away.

I feel no shame in asking my coworkers for help.  I'm not WonderNurse; I'm a new graduate nurse who's on a steep learning curve.  This is the "first year" and I am developing.   I would rather ask for the help, do the job right and let them think what they will of me for asking...than to say "I'll do it myself," refuse to ask for help and muck things up, because they'll think a lot worse of me if I do that.  They may be impressed when I have the good day and nothing goes wrong, but when the bad day happens--and it will happen...

I also have no problem asking for and receiving feedback from my coworkers, and I tell them to please tell me what I'm doing wrong--I won't take it personally.  I don't think they're used to that attitude because one of them looks at me like I'm crazy when I say that.  I don't think she believes me...oh well, she'll get used to me :)

It's been nice getting paid.  Our fridge went on life-support yesterday and it was my salary that got us a new one immediately instead of having to wait until his next payday.  It'll be here tomorrow and I can't wait--until then, I have to cram as much as I can into the mini-fridge and pray that doesn't give out.

Fun day

They put me on the intensive care unit.  Let's see...

• We had the delusional patient who spent the day walking up and down the hallways giving oratories.  Some were really good speeches, especially when the nursing students were on the floor and he had an audience.  Others, not so good--apparently we're all not qualified staff in his opinion and he wanted a court hearing to discuss his rights.  This was before he got into a 30-minute long heated argument with the security camera.


• There's the one that was refusing their meds PO...but they were legally mandated, so had to get them IM.  He was not happy about it--in fact he was verbally abusive and his agitation was escalating, so along with the charge nurse, they called in 5 male staff to help me give it.   Talk about a show of force:  they managed to pull up the burliest staff we have for this.  After a lot of cursing, swearing, and threats to come after us if anything happens because of this--much of this directed at me as I was the one with the needles--he got his shots and within an hour was sleeping.  It was all I could do to keep my knees from knocking the entire time. 


• The other mandatory IM was rather cooperative.  I also outweighed him by 100 lbs (seriously, he was skin and bones).  I still brought a male counselor because I had to...but after that first experience, this was easy.


• Bad news:  my first needle stick.  Good news:  it was a sterile needle--it happened as I was drawing up the meds for the preceeding patients.  I know why it happened--I was nervous about having to give the first patient described the shots.  After taking a minute to refocus, I started over with a new syringe.


• One patient went south on his new meds, and I had to play track down the doctor while we scrounged for more male staff to help him in the bathroom.


• Several patients were seeing and/or hearing things that weren't there.   Fortunately, most took the haloperidol I offered.   One didn't want it, but that was because the voices were only playing music and he was down with it.


• And it must have been national No-Shower day. 

Overall, I think I met the challenges pretty well.  I definitely can't say it was a dull day....I hope I don't have another day like it for a while.  And FYI to the nursing students who may read this:  if, when taking vital signs, you get abnormal results...retake them.  Then if they are still abnormal, tell a staff member about them.  Don't let us find out a couple of hours later from the vital sign sheet that someone's Stage 2 HTN but who shouldn't be.

In other news,  week 1 of Weight Watchers is complete, and I lost 5lb.  I'm still following up with the endocrinologist though because of the abnormal labs.

It's official, I'm an employee now

I did pretty well overall with orientation:  plenty of good feedback about my performance, lots of tips for improving myself, one med error d/t my not understanding a part of the MAR, and he only got half of his antibiotic dose.   It'll be kind of frightening flying on my own--really on my own this time, without the "orientee" safety net under me.  But I'm sure I'll be OK.  Just keep to the P&P, remember the 7 rights of medication administration, and yell for help before a crisis occurs and not during/after.

I need to work on creating a medication nurse cheat sheet, since that's what I'll probably be doing a lot of in the near future.  Then I'll make one for charge nursing.

I also got exposed to the office politics.  In my defense, the two nurses talking were sitting on either side of me at the station, so it's not as though I was creeping around corners and listening at closed doors.  But anyhow, I learned a few things about the place and some people, some good and some not so...of course, anything I heard I've taken with liberal doses of salt, as I prefer to find out more facts myself and make up my own mind about matters, instead of just going along with whatever I hear in passing.

I'm also intending to stay out of the politics as much as possible.  I'm really just there to be a nurse.

Long time, no update

When I was job-hunting, I was spending long periods of time on the computer, which gave me many opportunities to update this.   Also, I wasn't too exhausted by 6pm to get on the computer to surf the web and/or update.  Now that I'm working, I'm on the computer about 1/4 as much as I used to be...and when I get off of work, I do the home bit.  Once that's done, I'm too tired to fire up the computer.  I just want to have a glass of milk or wine (depending on the mood) and call it a night.

Work is going very well because  I didn't realize how much I'd enjoy psych nursing.  It's fascinating.  It's one thing to read about all of these mental conditions in a book, but to see them up close in person is amazing--the books don't fully describe how these conditions affect the patient every single day of their lives, nor do they fully explain what the experience of caring for these patients is like.    I--half of my nursing class, actually--would joke about how we were all OCD.  Well, I had a patient was truly OCD.  Answering a question was a minute-long process for her as she'd have to go through her rituals...and then when she was done, she'd look at you as though nothing happened and answer the question.  And she' would do that for EVERY single question, even Yes/No ones.   Though it goes against most therapeutic communication rules, I learned to pack as much inquiry into each question possible, even asking two questions at once if I had to...especially after it took 15 minutes just to pass meds to her alone.

I had a severely hallucinating patient who was convinced "they" were here to take her to prison, and were waiting in her room for her.  What "they" was changed frequently.  She wanted me to talk to them at one point, and though it was tempting to do it and humor her (and I guess humor myself), that would not have been therapeutic.  Instead I told her I didn't see anyone,  it must be difficult feeling so scared and that we were here for her, and would she like some PRN haloperidol?

She declined the Haldol...which was all right because two containers of chocolate milk seemed to be far more effective in resolving the evening's psychosis than her haloperidol has been all day.  Go figure.

I deal with a lot of detox patients.  I didn't realize how much people were capable of drinking, and how bad DTs can be.   I was doling out Librium like candy to one patient, who had such bad tremors he kept dropping them.   I also didn't realize how many medications a patient could have prescribed to them until I came to this unit...I thought the elderly were bad when it comes to the meds.  It makes one want to swear off the booze...almost.

There's a lot of depressed people too...in fact, it's a popular dual-diagnosis.  A lot of suicidal idealtion is there as well.  Those are the hardest for me to deal with because...I don't know, I guess I'm still getting over the mindset of "it's a mood, snap out of it and you'll feel better!"  But I'm learning patience, both with myself and with them as I talk to them.  Depressed people function at slower rates cognitively and I'm very much a "hurry up and spit it out!" person because I have 20 other things that need to be done yesterday.

It's all quite the learning curve.  I'm doing better than I thought I would be, though.  It helps that I've been looking stuff up in my textbooks when I get home.  I've also started studying one or two drugs per day:  the names, uses, common doses, side effects, etc.

I'm working out my own routine, and I'm learning the best way to do things...and some ways not to do things.  I'm also learning how different real-world nursing is from the ivory-tower textbook world of nursing. 

I still have pangs whenever someone talks of a med-surg job, but those pangs are decreasing as time goes by.  Plus, there's a lot of things in med-surg that I don't miss...such as Code Browns, various tubes and catheters, decubitus ulcers, immobile patients, and the extensive exposure to blood and body fluids.  I do get some med-surg stuff at work, mostly due to side effects of medications and medical problems they had before they got here...but any heavy medical care has to be sent out to a medical hospital.  So I'm not doing any Foleys or stuff like that.

My hours are pretty good.  I decided to work full-time (just) and I've been happy with the days/shifts I've gotten so far.   They've also been happy with my performance, so I think I'll come off of orientation with no problems.  Right now, my schedule is set through October.  I know they hired a bunch more nurses so I don't know if I'll still be getting as many of those days/shifts as I am now...but I decided that I won't worry about that because it will all work out in the end.  And if it doesn't, I'll pick up a PRN job somewhere...now that I'm actually getting acute-care psych experience, that is now a real option.

It seems like forever since I've been a student, especially since I now see nursing students come through the units.  I heard that a few more classmates got hired...I think nearly all of us are working now.  Most got into the hospitals in med-surg spoth, a bunch landed in nurseries, some are doing dialysis, and there's a couple at SNF.  Then there's the handful of us in psych.

In non-nursing news, I finally got the appointment with the endocrinology specialist set up.  I also joined Weight Watchers.  It's Day 3 and so far so good...though tomorrow will be the real test--that's when I'm going out with some friends.

First week over

It's been a busy week.  I've been on a few different units so I'm getting to meet more of the patient population as well as staff.  So far, all the staff have been good to work with.  The patients are interesting:  there's a wide spectrum of personalities there from very high-functioning to...well, the not very high-functioning.  Many of them liked to talk to me, probably because I was new.  One patient tried some staff splitting, but fortunately I went to talk to the tech about his request first.  Another patient made me nervous when I was assessing him since he went from completely out of it to completely coherent in mid-sentence and jumped up (so I couldn't help but bounce back a bit).  But overall I'm going in with a good mixture of bravery and caution.  And I'm getting very good at ensuring that doors are always shut behind me.

Nothing beats on-the-job training.  They may have explained the job to me in orientation, but to see it in action really makes me understand how all of the pieces of it fit together.  I'm learning a lot about what to do...and what not to do.  Not that the "not to do"s are doing anything wrong--it's just I'm seeing particular methods of doing things that, while they work for others, don't sync with how I know I work.

Right now, 95% of my job involves passing meds.  New nurses start off with passing meds, then they start charting, then they progress up to charge nurse roles.  I really need to get cracking on refreshing my medication knowledge, especially side effects and how fast they take action, because in the last unit I was on there were a lot of medications given out that needed to take action fast.  I also need to learn brand-names because most of the orders use brand-names while I know the generic names.

I've also seen how manipulative some of the patients can be, especially when it comes to meds.  On the first day, some thought that, with me being new, they could pull one over on me and ask for extra doses "because that's what they always take/that's what the doctor changed it to/so they don't have to come back in an hour/whatever."  To which I smile and reply, "I'm sorry, but I can only administer medication as ordered in your record."  Repeat as needed.  After a couple of days, that stopped.

Next week I'm on the higher acuity units, so I've started thumbing through my psych textbooks just to refresh myself on the basics of the common psych conditions.

In the non-nursing world:  I see the endocrinologist next month.  Until then I've been doing the DVD, working out on that treadmill and watching what I eat, and it's still a losing battle.  I won't step on the scale--I'm going by the fit of the clothing.

Right now, I need a nap.  Horror movies + Dr. G, Medical Examiner = strange dreams and a none-too-restful night's sleep.

LONG week...and the "First Year" begins.

Every night after orientation, I'd do the home bit, stay awake only as long as I had to, then pass out because I had to get up at 5:55 the next morning.   Most days had working lunches, few breaks, didn't follow the schedule...and often ran behind schedule, so there were a couple of days that ran late as well.  So the last thing I could bring myself to do was sit at a computer and type...sorry about that.

Lots of videos and slide presentations:  customer service, OSHA, therapeutic boundaries, blood-borne pathogens, CPR,  fall prevention, documentation, deescalation techniques, crisis management, safety, breaking holds and physical maneuvers...and lots of tests to accompany each educational session.   I've signed my name on sign-in sheets and test papers so many times my hand hurts thinking about it.   There was a lot on restraints and seclusion...and understandably so, given the nature of the business.  And there was a lot about drugs, and again, understandably so.  I realized on the last day how little I really know about medications used in psychiatric nursing.

Then there was also a ton of administrative stuff too: P&P, scheduling (that was a fun day as at first we thought we'd be competing against each other for shifts...not the case, thankfully), benefits (for those who got them), rules, regulations...every night, I carried home a small tree's worth of paperwork for my records.

By the last day of orientation, we were all punch-drunk from being in the same classroom for 40+ hours that it was hard to focus on anything.  Thank God I am getting paid for it--I don't think I'm that desperate for work (or masochistic enough) that I'd have done that week for free.  I meant to review drugs and the P&Ps this weekend, but I was so wiped from the week that I slept 11 hours  each night for the last two nights.   

My first day is today...in a few hours, in fact.  For the next month, I'm on another orientation so I'm not expected to do everything by myself from the get-go.  This month is all about learning on the job.  Then after this month I'm still on orientation for another 5 months but they'll expect me to work just as any other nurse would.

It was on the last day of orientation--and again this morning--that the enormity of what I'm doing hit me, that I wasn't in Kansas...er, school anymore.  I am no longer a student with a safety net.  I no longer have my ignorance or instructors to fall back on.  The excuse "I'm just a student" or "I didn't know, I don't work here" will no longer fly.   I am going to be working as a licensed registered nurse.  I'm going to have serious responsibility.  I'm going to have a lot to learn and a good portion of it I will have to teach myself.  I'm going to have to be very independent.  I am going to have to know what the P&P are as I do "work here" now.  My license in on the line from here on out, and the one and only person that is responsible for protecting it is me.

It kind of makes me want to throw my hands and say "maybe I should wait a while longer before I start."

But I know that the first year of nursing will be a learning curve--it is going to be rough no matter what area of nursing I went into...but I'm not going to get through it until I actually start it, you know?  After all, all of the nurses there went through the first year--it's not as though they emerged from the womb like Athena, with DSM-IV-TR in hand and ready to hit the floor like a seasoned pro.

I guess I'm a little nervous about beginning so soon.  I had no choice--I have to get a certain number of hours in during the first month so I had to put in for a lot of shifts.  So wish me luck tonight, as I will need it.

In other news, I'm still trying to get the endocrinologist appointment set up.  My little one starts school on Tuesday...the poor guy will be plunked there at 0600 as I have to work that day shift.  I hope he'll be all right...I took him there on Thursday to show him around and meet his teacher.  He seemed pretty excited about it, but I'm also not sure it's sunk into his mind yet that he's not going to his usual provider but to school.