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 though...in 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  She was relieved when I had told her that I had withdrawn.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 environment...it 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.

The ED Interview

I'm back home.  Still adjusting to a world in which my father isn't physically here anymore...it'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 drop...in 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.

*sigh*

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.

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.

Waiting

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.

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.

Ups and Downs

Up:  I have started a preceptorship in the ED...as 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 preceptorship...so 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.