I'm alive! And a new path...?

 What has it been, more than two years since I last wrote?  Yeah...life has been busy.

To give you the Readers' Digest version of what has happened in my life in the last two years:

• Adopted a puppy...who is no longer a puppy.  It's nice to have a new dog in the house.
• Had to take a break from moderating duties at the forum because graduate school was just too much work.
• Went to Spain to see family. It was my first time ever in Europe.  If I could move to Madrid, I would.
• Was transferred to a new home unit at work.  I was spending so much time on the psych ICU that they finally decided I should officially be assigned there.  So I was, and then the next day, immediately floated back to med-psych.
• Moved to an even smaller town in the mountains.  Smaller house but more land.  I love living in the middle of nowhere.  There's definitely a lot more space, a lot fewer people, a lot more livestock, and a lot more wildlife.
• Went through three advisors in graduate school.  The first was there only a couple of months before she decided to return to a job in the NICU.  The second was awesome!  We were together for most of my time there until she decided to take a job with the state Department of Public Health.  At this point, COVID-19 was still in its infancy, so she had no idea what she was getting into...
• Oh yeah, COVID-19.  Life upended.  Kids home constantly.  At least in my new small mountain town, I could go outside and not have to mask up like I was going to see a TB patient.
• COVID and I became intimately acquainted.  It was the 10-day headache.  Fortunately, the recovery was quick and full.  And fortunately, the family was spared.
• Graduated with my MSN-ED.  Did not leave my current job as it pays too well.  Plus, I never planned to immediately go into education...that's the long game, for when we leave the state and/or I decide to leave the bedside.
• Got through the strangest holiday season.  My mother decided to fly out from the east coast for two months, so every two weeks, she would shuffle between my home and my sister's home.  
• Meanwhile, our governor was busted violating his own health rules, so he threw a hissy fit and closed the state down through the holidays while she was here.  This meant we couldn't do much except go to the parks and the reservation casinos.
• Things started getting back to normal-ish after the holidays.  
• I was offered the COVID vaccine.  I declined it for now.  I'm waiting for the data on its long-term effects and possibly even on the final FDA approval for one of the variants.  Then I'll consider taking it.   Plus, I have bad allergies which make me very hesitant about taking experimental vaccines.

Which all brings me to now...

I received an interesting business proposition...which requires me to be a psychiatric nurse practitioner.  Since I wasn't rushing to go right into education, I decided to think about it.  

I have a MSN, so I'm already part of the way done.  I could afford school without having to take out a loan (though I'd fight like hell to get as many scholarships as I could!). I'd have a set spot for my clinical hours. I'd have a job when I graduated.  And even if the proposition fell through, having the NP would give me more career opportunities, especially if I am planning to leave the state. 

Overall, I think pursuing the NP might be worth it.  

So let's go apply and see what happens.  After all, I'm not committed to anything by applying, right?

And so it begins...

The new grad postings for my healthcare organization are up.  Yes, it's that time of year when the new grads finish up their residency and start jockeying for the spots.  No guarantees...though of course, if you're aiming for a particular spot, it helps if you have an "in" somewhere in that department.  Then the department manager has a name to ask for when they submit the posting to HR.

We have a new grad coming our way next month.  Their "in" was that they were a per-diem CNA/tech for us.  And now they're a nurse for us.

We're actually doing pretty well in the new grad front.  We've had quite a few of them over the last couple of years, and so far almost all of them have stuck around.  It's nice to see that there's new nurses who are really interested in psych, and not just using it as a way-station to get their golden first year of experience before moving on to another specialty.

In which Meriwhen cries at work

I've only gone misty at work a few times in my career.

First time was as a new grad.  The powers that be decided I should be in charge of the ICU that day.  Well, I had never been in charge of the ICU--it wasn't even my home unit.  Up until that point, I was primarily a detox nurse.  And it was a day full of discharges, court hearings, and everything administrative. I can deal with psychotic patients until the cows come home, but administrative stuff and court hearings...yeah, not yet familiar territory.   My other nurse (we were short, so there were only two of us) was also a float.  She was also a LVN so what she could do to help me was limited in scope.

I did my best to make a go of it, but after an hour and a half, I was so overwhelmed, I had to call the DON for reinforcements.  She was able to get the supervisor down there, as well as one of the regular ICU nurses to come in on his day off and help me out.  God bless him.  He helped me get through the shift and gave me a crash course in all the legal ins and outs.  He remains a good friend to this day.  We both have the same taste in firearms.

I managed to keep the water works in until after the shift, when I went by the DON's office.  She invited me to stop by to see how I was.  I got there, sat down, and promptly started bawling.

The second time was many years later, on the first Father's Day after my father died.  I went to work four days after he passed and didn't cry.  I didn't cry for a long time.  But that first Father's Day...I was on the open unit, so fortunately I got to be alone in my misery.  Patients slept all night and it was so slow that my partner was chatting with some other nurses.  I sat in the corner with a COW (computer on wheels), quietly, with the tears streaming down my face.  I think that was the first time I had cried since he died. 

I haven't really cried for him since...I do get misty at times, especially on my birthday.  But brief tears since my father would have never liked to see me get upset on my birthday, especially about him.  And I've never really cried over him since...but I know he understands.

Third time was due to stress over my mother.  I love my mother but she can drive me to tears.  I don't remember exactly what it was that got me upset, but with my mother, it could be lots of things.  And while my crying wasn't outright hysterics, it was enough to get people worried.

Which brings us to the fourth time, today.

I generally have a good relationship with my coworkers, especially the ones I work with the most often.  You need to have it, it's part of surviving.  But work has been very stressful as of late--unfortunately things have happened and I can't go into details.  It's getting to a lot of us.  At least, it's getting to me and a few who have confided in me.  We're doing our best to support each other in this.  Anyhow, one of my coworkers--normally a decent guy--has been acting kind of like a jerk lately.   He said something to me and it actually hurt.  I asked for help with something and I got this instead.  I'm not entirely sure if it was meant as a joke--I'm kind of thinking/hoping that it was, but it still hurt nonetheless.

I know, Meriwhen, sensitive?   Not usually.  But like I said, things have been stressful lately.  So the remark got to me more than I'd like to have.  I didn't quite know what to say, or even if I wanted to say anything about it, so I have just been keeping my distance from said coworker.  Not really talking to him other than what I had to say while I thought it over.

I did end up talking about it with another coworker--the topic just kind of came up.  He was also there and heard the remark, and agreed that it was rather insensitive, especially since I never ask for help (and yes, I'm working on improving that) and didn't get why the coworker said it, even if it was supposed to be a joke.  He's also been a bit frustrated with this first coworker as of late.  We both concluded that he (first coworker) probably hasn't even noticed that he upset me and so it might be pointless to even bring it up, just to let it pass.

So while an apology might be nice, my second coworker has a point.  As far as remarks go, yes, it hurt...it wasn't the worst thing I've ever had anything ever said to me.  Still, it was nice to know that perhaps it just wasn't me being overly sensitive. 

But now, the first coworker for some reason is now not really talking to me.  We have somehow entered a cold war...maybe.  Or maybe not.  I haven't asked him.

It hasn't impaired our working together, but it was tense.  And got tenser as the night wore on.

Finally, towards, the end of the shift, I couldn't take the tension anymore and started crying in front of three psychotic patients.  Two of them--long-term patients--were very concerned about me.  The third said he would get us an apartment to live in together and buy me a sports car.

Uh, no, thank you.

I excused myself and left the floor.  I'm a firm believer in presenting a united front when it comes to patients, and any issues among staff is not patient business.

A third coworker (I have to number them now so you're not confused) found me and consoled me.  I didn't really say why I was upset.  I'm not sure if anyone else knew I was upset because I did have the waterworks under decent control.  Others including the first coworker were going past us in the nurses' station, so maybe they noticed.  Or possibly not.  No one else said anything, and I was too upset to care who saw at this point.

I pretty much ran out of Dodge after that.

And that, ladies and gentlemen, was the fourth time I ever cried at work.  I'm sure they'll be a fifth, but hopefully not for a long time.

As far as the first coworker...I don't know what to do about that situation.  It's inevitable that we will be working together again. He really is a good guy and I genuinely enjoy working with him.  I'd like to think that his remark was a poor joke made at a horrible time, and which I for some reason am having a hard time getting over.  Things are stressful at work for all of us, and the holidays are just going to make it worse.  And December is a horrible enough month for me as it is.  Maybe it may just be better for me to let it go and try to get out relationship back to normal.  If he asks about it, I'll tell him how I felt.  Though I don't think he will.  I think it's just like my second coworker and I think:  he probably hasn't noticed anything was/is wrong.

Though I'll be honest:  part of me never wants to ask him for help with anything again if I can help it, in case it wasn't a joke.

Stuff

I finished Research.  It turned out that I aced this one...it came back with a nearly perfect score.  It'd be nice if WGU thought it merited an excellence award, but I guess it'd have to have a perfect score to get that.

I got a few recruiting pitches.  The most notable one was from ICE...yes, that ICE.  Apparently psychiatric nurses can have flourishing careers in Immigration and Customs Enforcement.   And apparently they saw me on LinkedIn and thought I was a good candidate.  I'm going to guess that they saw the last name and figured I was likely fluent in Spanish.  I'm working on it.  And Russian.

Yes, Russian.

I had always wanted to learn it as a kid and even got some sort of course to start with.   But it was no Rosetta Stone and didn't really make it stick.  I decided to take advantage of a summer sale to add on Rosetta Stone Russian online.  I work on Spanish classes during my lunch breaks.  I started working on  Russian classes when I'm on the treadmill.  As far as practice goes, surprisingly there is a sizable Russian/Ukrainian community in my town. 

Anyhow, back to the recruiting pitch...I admit, I was intrigued.  ICE?  Me?   Meriwhen in a green and white car?  It would coordinate with my blog's theme. 

Ah, no, not now. I'm not planning to leave my current gig any time soon, as it took me so long to land it in the first place.

I went on a short holiday.  I brought my laptop with every intention of opening it up to do schoolwork, but I opened it up to look up local attractions and indulge in some late-night Minecraft.  So I technically didn't begin my next course--Informatics--until this past Monday. 

I'm now about a week and a half behind my arbitrary deadlines, but that's OK.  My first program mentor had set the dates up so I'd finish in mid-November, leaving me with 6 free weeks.  I opened up my iCal and plugged in the actual dates, and made a few adjustments.  My adjustments have me finishing in mid-December...on my birthday, actually.

So, for Informatics...

For this class, they recommend taking part in as many of the live cohorts as possible.  I threw myself right into the first live cohort, and the second will be today.  My schedule won't let me hit every cohort, but I can hit two a week.

I went to the first one, which was taught by my assigned course instructor.  So she's going on about the course and mentions an informatics scenario that sounds suspiciously like it occurred in a psych setting.  I could relate.  So she continues on and it turns out she IS a psych nurse.  Well, she's in Informatics now, but she's a psych nurse at heart and loves it.

It was all I could do to keep from squealing.  A fellow comrade from the dark side!

The course being Informatics, she couldn't talk psych nursing for long.  But I must speak with this instructor more.  Since I'm planning to approach the performance assessments from a psych perspective, she will be a valuable asset.  Speaking of which, this course has two performance assessments independent of each other, and I get to use PowerPoint for one of them.  Should be fun.

I'm sick of Translational Research

Don't get me wrong:  I loved the content of the course.  I'm just sick of working on this performance assessment for the last two weeks.  I'm already 4 days behind my arbitrary deadline.  Tomorrow will be day 5, but it WILL be the final day of this course as I plan to submit my performance assessment before lunch.  I already did the Turnitin check (6%, well below the guidelines).  I have a last review of it with the Writing Center, then I'll give it a final once-over, and then this toast is toasted.

Today was the weekly check-in with Belle.  I'm strongly suspecting that she's got a strong psych background, if she's not actually a psych nurse.  We spent 5 minutes discussing my weekly progress and 10 minutes discussing adventures in psych nursing.   And she was excited to discus psych as well.

Someone who understands my life!  This pleases me.

I also came to the realization that I REALLY do need those arbitrary deadlines. Don't get me wrong, the self-pacing of the WGU program is great.  But I realized today when I was on the 7th draft on my project that, as I told Belle, I could continue to revise this thing until the cows come home.  Instead, I need to work up to the deadline, submit it, and move on to the next course.  If my performance assessment truly blows, they'll send it back for revision.

I realize that may sound confusing to fellow students, and it confuses the hell out of me to.  To revisions/revising in WGU lingo typically means that your performance assessment was kicked back because part/all of it didn't meet the rubric standards.  Whereas in my lingo, revisions/revising means to edit yet another draft.  The previous paragraph makes it seem like my performance assessment failed 6 times already.

Moving to non-graduate school topics...

I went to the Cheesecake Factory today.  The menu is rather scary...well, not so much the food as the calorie counts listed next to the food.  There was very little in that main menu book that wasn't in the quadruple digits, and a few of those digits even started with 2.   But since I was there last time (which was probably 2012 or 2013), they have introduced an additional menu of lighter-calorie fare.  In this new menu, I'm pretty sure that no one item exceeded 1,000 calories.

I recommend the White Chicken Chili, by the way.  Excellent flavor with a nice spicy kick.  The Chicken Samosas are good too.  I had both and still kept the total calories in the triple digits.

I do regret having the Cinnabon Cheesecake though.  Which, by the way, is not on their new menu as it's about 1300 calories.  But when one is at the Cheesecake Factory, one has to have the cheesecake.  Otherwise, why go to a place named the Cheesecake Factory?  Anyhow, I thought that since I've been able to eat cheese with no issue as of late, that perhaps I was able to tolerate dairy again.  Alas, that was not the case...though it was a very tasty way to put myself in agony.  But next time I go back there, I think I'll have to settle for the bowl of strawberries instead.

Sticks and stones

Happy Easter.  Or Passover.  Or April Fool's Day.  Or Sunday.  Whichever holiday(s) you celebrate.

Just the other day, there was a patient who was unhappy that I had set firm limits.  So for the entire shift, I was yelled at, berated, harassed, taunted, made fun of, you name it.  The patient kept doing it because they thought they could get a reaction out of me, so they trotted out the worst verbal barrage they could short of physically threatening me--which they were wise enough not to do.

For almost 10 years, I've worked on the worst of the worst psych units, so the bar is set really high if you want to use your words to upset me. 

So, for all their efforts at getting that rise, the best the patient got was a smile or a neutral expression followed with a laconic "OK."  Or "I know."  Or "Whatever you say."  Or whatever other noncommittal benign remark comes to mind, followed by as-needed reiteration of whatever limit was being challenged.   And naturally, complete documentation of their behavior which is then discussed with staff and the MD so we were all on the same page, because attempts at staff-splitting usually go hand-in-hand with such behavior.

I can usually talk a patient into dialing their behavior back once they see it won't get what they want.  Sometimes they figure out on their own that it's not working and give up.  But occasionally, I get a persistent one that is hell bent on leather, and no matter what I would say, it will be ineffective.  I can usually figure out that they're one of those pretty quickly.  Most psych nurses can--it's an essential skill that we must develop in order to survive. 

I don't engage any more than necessary as then it would become a power struggle, and some things on the unit just aren't and can't be open to negotiation.  Sometimes I think I should just not say anything and ignore whatever is being said, not even give that "OK" or whatever laconic response.  I decide not to as that may give the impression that a. I didn't hear them, b. I'm ignoring them and/or c.  what they are saying is getting to me...and any one of them just feeds the fire even more.  If they think you didn't hear them or are ignoring them, they'll just keep going on until they do get a response.  If a patient--especially someone with an Axis II diagnosis--thinks they've found a weak spot of yours, they will go after it like a bloodhound.  Show them that something they said upsets or otherwise gets to you, and they'll latch onto it and keep launching barbs.

Caveat:  if they are acting out, then as long as they're not hurting themselves or anyone else, the temper tantrum is ignored until it is completed.  It's the same as Toddler 101.

I try to avoid getting assigned to such patients once I know they have it in for me...in fact, they often weren't my assigned patent in the first place!  After all, there's a fine line between standing your ground and rattling one's cage.  For me to willingly assume care of a patient who considers me Public Enemy #1 for whatever reason is not very therapeutic for them, nor would having to deal with me as their nursing contact "teach them a lesson."  If anything, I think it comes across as antagonistic:  "gee, you don't really like me, do you...well, guess who's your nurse today!  Ta da!"

I have to admit that over the years, I've had some very creative insults and names hurled in my direction.  I would love to share some of them, but I prefer not to run afoul of privacy laws or my organization's management.   Oh well.  Perhaps many many many years down the road, I'll publish a book that'll be released after my death:  The Meriwhen Diaries:  Detailed Adventures in Psych Nursing.  And it'll be full of all the stuff that I wish I could have shared now but can't due to privacy concerns...but which in 40 years or so, would be impossible to tie back to specific people.  

The bane of my existence...

In the last week, I attempted 23 IV starts.  The one I managed to get in was later determined by the MD to be not good enough for his purposes...so essentially, I batted .000.  I did get one successfully started the week before, and on a psychotic hallucinating patient, no less.  So for the whole month, I'm 1 for 24, or 4.166% percent successful.

My IV skills are not improving despite hell AND high water.

I decided that it's time I broke down and took a LVN IV Therapy course.  So I went to the BVNPT website and found local approved course providers, and messaged them for more information.  I suppose since I'm not going for BVNPT certification, I could take a course that wasn't approved by them.  But I consider the fact that a course has BVNPT approval as meaning that the course content is up to snuff.

That is the downside to working in psych:  we almost rarely start IVs.   Psych-medical sees more IVs than the rest, but even then, it's nowhere as many as you'd see on your typical med-surg floor.

IMs are no problem:  I can give an IM to a patient under pretty much any conditions.  And have.

So while I wait to hear back from the courses about enrollment, I'll be pulling out all my IV books and reading them...again.   I wish they sold an IV practice kit that didn't involve a human body part.

Whee

The little ones are on Spring Break, which means I've had to adjust my sleeping schedule.  I now sleep in the evenings, go to work, then stay awake to do things with them.  It's been working out so far...its a nice change to stay up after work, and I'll admit that it's easier to fall asleep when it's starting to get darker out as opposed to brighter.  But this won't work when they're back in school, so in a couple of days, I need to return to my regular schedule.  I may shift back to this in the summer, we'll see.

I've been enjoying the last few days off.  I've caught up on sleep.  I'm spending time with the family.  I've turned down requests for work.  I'm just recharging the batteries, getting ready to once again tackle all of the Axis II that seems to have infiltrated the patient population.

The tough thing about personality disorders is that they are how a patient is wired, meaning that nothing is going to cure it.  Sometimes I do wish it was like psychosis, where a shot of Haldol will make the pink elephants go away...at least for a while.  Alas, it's not.  Medications may help them manage their symptoms, but the patients need some good old-fashioned therapy--usually CBT or DBT--to change how they think and respond.  But because they are wired this way, it's also incredibly hard to effect change.

All the Axis II can wear a nurse out after a while.

I'm debating if dealing with Axis II disorders is more exhausting than working with patients in mania.  Both can be challenging, frustrating, and have medications end up with little to no result.

But a manic patient with Axis II...now THAT'S a hurricane!

I broke 20

21 lb lost to be precise.  But today, I'm back across in the high 19s, but I did have barbecue for dinner:  a French Dip sandwich.  And that au jus is seriously a liquid salt lick.

I had a patient yell at me for most of my last shift.  Reason:  I existed.

They started in on me, in full-on oppositional form and at the top of their lungs.  After a couple of attempts at reality orientation--which they were not receptive to--I told them, "OK, whatever you say" and went about my business with my poker face on.   I learned early on in psych nursing not to argue with actively psychotic patients because it's an exercise in futility.   They're going to believe what they want to believe, and no amount of discussion is going to convince them otherwise.

Said patient didn't really like that I was not standing there being a willing target, that they weren't getting a visible reaction, and that most of my responses were "whatever you say" or other blandness.  They tried bating me by calling me a few choice names, but that didn't work either...after several years in psych, I've already been called every name in the book plus a few new ones.  So if you want to offend me by calling me names, just be aware that the bar is set really really high.

Said patient kept ranting on until they found another person or object to briefly distract them, then returned their attention to me.  They were also manic, so their energy didn't wear down.  They kept it up until the moment I left.  Something about me must have touched a nerve with them, I guess.

Funny thing was, they weren't even my patient.  I just happened to be on the floor that shift.

Just a typical day at work.

Only in psych nursing is playing cards with a patient not only allowed, it's also a therapeutic intervention

Try doing that on a med-surg floor and see what happens.

Anyhow, it was a slow night so I played some Gin Rummy with a patient....well, with a patient and their hallucinations.  It was a fun game.  The patient was a very good player, though every so often, the patient would stop and respond, or start conversing with one of the voices.  Sometimes I wasn't sure if the conversation was directed at myself, the voice(s), or both/all of us.

I lost most of the hands.  It was an uneven match-up if you think about it.

Something in psych that I always find amusing:  a patient will dislike, even hate me, with a complete and utter passion...and 30 minutes later, I'm their BFF...and another 30 minutes later, I'm back to being their mortal enemy.   Lather, rinse, repeat.   Sometimes these shifts are due to medications given, sometimes they are due to memory issues, sometimes they are due to the psychiatric disorder itself.  Or all of the above.  

One thing is certain though:  I never ever take it for granted that a patient likes me.  More than once I've found that the patient that was all hearts and flowers and cooperative with me yesterday is defiant and lobbing chairs at me today.  So I approach each day--and often, each and every interaction with the patient period--as though I don't know where I stand.  And I also stand a little further back than I can think they could throw that chair.  It is much safer that way.

A little break

After working a stretch on the psych-medical unit, it was a nice break to be floated to psych stepdown.  I spent the last several shifts wrestling with IV machines, suction and oxygen tubing.  Sometimes all with the same patient.  And all the call bells that go off when the bed alarms are triggered!  When there's a restless patient, it seems like their bell never stops ringing no matter how low we set the sensors to.

I have remembered that I dislike suctioning.  Phlegm is my kryptonite.

In an attempt to accelerate my getting up to med-surg snuff, I got a couple of med-surg reference books for my Kindle.  While I will always be a fan of paper books, the Kindle makes it possible for me to have all of my reference books with me while at work.   Plus I love the fact that I can order it and have it delivered within minutes.

I've also started looking at a few med-surg and LTAC CEUs.  I have to accumulate 150 of them by 2021 to renew my certification, and only 51% need to be in psych; the rest can be in whatever I choose.  So I'm going to kill two birds with one stone there.

Anyhow, back to stepdown.

Loads of manic patients.  The mania is very strong in the air as of late.

I generally tend to get along with patients in mania, though just watching and listening to them wears me out.   The rapid hyperverbal speech, the hyperactivity, the flight of ideas as they jump from topic to topic, the delusions of grandeur…it really is exhausting to keep up with them.  Still, it's a nice change from answering call bells.

It’s frustrating when PRNs don’t slow them down at all, especially when it’s the middle of the night and they’re waking other patients up.  I tell them repeatedly that as long as they can keep it quiet they don't have to return to bed (some of my peers do not agree with this strategy.  I am of the mindset that as long as they are behaving or not in danger of being hurt, I don't have the right to force them into their room).  The problem is that they’ll be calmer and quieter for a minute or two.  Then the voice and energy level naturally starts escalating again.  

At one of my previous jobs, we would utilize that energy for good and have manic patients fold towels or tidy up the common area.  Depending on the patient, they might get a broom and dustpan and be put on sweeping patrol.  Of course, this is if the patient is willing, which they usually were since they had all this energy to burn.

But it’s harder to manage at night.  During the evening, when everyone else is awake and active, having a manic patient or three is one thing.  At night, when the goal is to have all the patients sleeping…well, that’s another. Sometimes the PRNs need to be “strongly” encouraged.  While I hate pressuring patients into taking medications, it's better doing that than to have them wake the psychotic patients who would pose an even  bigger problem if THEY were awake.

For all the exhaustion working with manic patients can provide, one of my favorite things is to listen to two manic patients have a conversation.  They will be discussing two entirely different things at high speed and yet still understand each other perfectly.  It's amazing to watch.

But the manic patients are asleep tonight...for now, anyway.  It's the religiously preoccupied and delusional that are awake and roaming.  I've been lectured once already on how I'm going to hell, which is a nice change from just being told that I'm going to hell:  at least now I'm having the why-I'm-going-to-hell explained to me.  I'm apparently holding another patient hostage.  But at least the patients are being so polite and friendly about it with me.

Psych nurse grieving process...or, it's been a while, hasn't it?

It was a tough few months getting over my dad's death.  I think because his death was expected, even down to the when and where, I think I probably went through the stages of grief in a pretty skewed fashion.  Denial was short.  I think I skipped anger and bargaining, and I came to acceptance really fast.

Depression, on the other hand...well, I've been stuck in that for months.  It came on last, and it's only recently that I feel like I started hitting the upswing and working my way out of it.

I think in the entire time since he passed, I only had one or two days where I broke down and cried.  I don't think it was (is?) dysfunctional grieving; I just didn't have it in me to cry a lot.  I didn't cry the moment he passed, I didn't cry during the holidays...it just took several months before I did break down.

His birthday and Fathers' Day have passed since he did.  Both tough days.  I can't remember the exact day I broke down and lost it, but I'm sure it was on one of those days.

I found an old voice mail from him on my cell phone...rare because I almost never save messages; rarer still that he actually left a recording.  I found it and immediately ripped it to a mp4, then made a backup copy.  Well, copies.  And then locked the ones on my Mac so they can't be deleted.  It's comforting that I will always be able to hear the sound of his voice.  And of course, I have plenty of pictures of him.  He's in no danger of being forgotten by me anytime soon.

I even talked about him with a patient who was grieving the loss of their spouse.  It was nice but it did get both of us sad...so we switched to talking about our dogs to cheer ourselves up.

I sent him back to my mom.  Her grieving has been harder than mine, understandably, and she felt that she needed him back home to feel better.  Within a hour of that phone call, I was at the FedEx store with him, making arrangements to overnight him.  I learned that he's now 11 pounds.  I also learned that FedEx will not ship human cremains.  And that it was incredibly hard to assign a monetary value to dad for insurance purposes.

So I took him to Office Max, got mailing supplies, rewrapped the box in plain brown paper (the nice FedEx people had done a nice job of packaging him for me, but the box had their logo all over it), and sent him overnight by USPS.  Having learned my lesson from FedEx, I listed my dad as "mementos" valued at $100.  

Sorry, Dad.  But I had to get you home.

Of course, my father being my father, he didn't get their overnight.  He got waylaid at a border city.  I told my mother that one of the things that dad wanted to do but never got around to it was to go see Mexico, and so he was making up for lost time.  She thought that was funny.  Then he got stuck in Kansas, and my mother told me, "your father always has to take the long way."  Our family does have a warped sense of humor.

But he eventually made it home, and my mom is much happier.  In a way, so am I.  I think he needed to be with her as much as she needed him to come home.

I'm still working on the motivation and the isolation.  I'm making an effort to be social again, both in person and online.  I started attending the knitting group again.  I need to start going to the nursing forum and doing my work.  They've been very patient with me through all of this and I've grateful, but I feel it's time for me to get back to earning my kibble there.  

I am enjoying nights on the permanent job...not sure if I'll ever return to days.  I still dabble with Job #3 from time to time just to keep my foot in their system.  It's such a tough nut to crack into in the first place, that I'd be a fool to sever all ties with them.  

I know that I can sometimes be slow on the uptake, but only recently that I realized that my main job is the weekend position that I had applied for more than 4 years ago but did not get because I did not have my BSN.  And it is the psych-medical position that I spent an hour alone talking to the director about.  I don't know if she remembers me from that time.  I hesitate to ask.  But here I am, I finally got here...and happened to learn about nursing and about myself along the way.

I'm even started thinking about starting the MSN...decided that I'm going to pursue a general one or one in education.  I decided against becoming a nurse practitioner.  From what I've been seeing, it's mostly prescribing and limited patient interaction.  I'd rather have the patient interaction.

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.

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.

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.

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.

Mania

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.

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.

Last shift I worked, we had a new grad orienting on the unit.  Very enthusiastic, friendly, and happy to be there yet appropriately wary enough (rule of thumb in psych nursing:  it's better to always be a little wary than get complacent in your surroundings).  She also had an actual interest in psych...in seeing her in practice during the day, she wasn't one of those "I just want to get my year's experience and then go to a glamor specialty" types--it appeared she had a bona-fide interest.

Of course, she made me feel old, as my new grad days were a few years ago.   Her age range was quite a while ago for me as well.   I feel my age more at some times than at others.

Still, it's heartening to see new grads who actually want to enter the specialty.  

It was a good day.  Good coworkers, a new grad who was more an asset than a liability, good patient population, and no major issues.  A couple of minor ones:  I was Pyxis-challenged at one point in the shift, and later on I had to literally chase down a doctor to get a PRN order.  Fortunately, I was able to corner him, also literally.  That's the nice thing about both small units and my wearing running shoes to work.

I also got approached by the unit manager.  Apparently my reputation has preceded me, and it's a good one.  She (and some other staff as well) was feeling out whether I'd want to work on the unit permanently.  And I actually like the unit I was on, so such as offer would not be unwelcome...just not now.  Hopefully she'll feel the same way about me next year when I can do it.

I worked on a paper for my class today...I whacked out a rough draft and hope to have it turned in by Sunday.  Originally, I set the deadline for this assignment a couple of weeks prior.  I figure if I can do the paper and two more assignments this month, this leaves me nearly two weeks in December to do the final exam.  Though this means I still have to get through all of the remaining video lectures and readings in this month as well.  Fortunately my schedule did fill up but not to the critical mass point of the last few months.  Though part of that was due to having to block out several days for dental, medical and psychiatric appointments, as it was due to fluctuating census and staffing needs.