Two years in the ICU

A little background: I have spent the last 2 years working in a medical ICU working with a wide array of patients and their diagnoses from detoxing, diabetic ketoacidosis, congestive heart failure exacerbation, GI bleeds, terminal cancer, sepsis, respiratory failure, and even a couple of West Nile virus cases. I have learned so much about the human body and the journeys it is capable of surviving, but I have also learned so much about myself. I needed a place to write my thoughts and so I have returned to SageBrushRN to explore those ideas.

ICUs are able to combat and correct a lot of things. I am most proud of my moments when I've had a chance to feel like I made a real difference. I've had patients come back in a say thank you for getting them through a pneumonia, a heart attack, a freak infection that came out of no where, and various other maladies. 

However, what I was not prepared for in ICU was the torture care of terminal patients. When I say "torture care" I mean cares that are done to a patient that is very clearly not going to survive but we are still doing everything possible like we still have a chance to cure. 

I have cared for people for weeks with tubes coming out of every orifice that are unable to communicate but still grimace with every position change every 2 hours. I have lost a little of my soul to these patients that will spend the last hours of their precious lives being poked and prodded under fluorescent lights in the ICU. I have wept when we have coded the same person time after time because the family has no idea the violence of a code and would rather subject their love one to another Code Blue rather than hold their hand and savor what time is left. 

I have recently read Atul Gawande's book Being Mortal and it gave voice to all these feelings I have been grappling with over the last 24 months. Our medical culture is inept at dealing with mortality and we rather flail helplessly against certain death in an attempt to make ourselves, not our patients feel better. 

Gawande sites a study about palliative care where patients with Stage IV lung cancer  were randomly assigned to receive either usual oncology care or usual oncology care plus palliative care specialist care. The following is astounding,

"...those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experience less suffering at the end of their lives - and lived 25 percent longer (his emphasis, not mine). In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality (Gawande, Being Mortal, 2014)"

I got into ICU to save lives, but the longer I am there I realize the majority of what I do is prolong suffering of both patients and their families. I got into nursing to serve others, to relieve their suffering, to make the world a better place. I do not fear death, I fear suffering as a patient's last memory of this world. 

When I've worked with families and doctors wise enough to recognize and accept the end of life I have been honored to be death's midwife and remove the trappings of ICU and provide relief from pain and suffering to let someone pass. When I can remove the lines and let a mother hold her child one last time, or a spouse snuggle in for one last hug that is the comfort my patients deserve - to feel love and security from those who matter most to them.

It is with relief that I am now leaving CCU. It was an honor to work with such brilliant nurses and to be part of a such an efficient team. However, I have found that my nursing practice and my nursing soul need a change and will find that change in the new journey of PACU nursing...

Back to nights: the space to think and teamwork

I had mixed feelings about returning to nights 2 weeks ago, however, as my preceptor, who has the exact voice of Quagmire from Family Guy stated, "you have time to critically think on night; days you just try to survive."

The first night I was able to successfully handle 2 sick ICU patients on my own which was the boost in confidence I had been seeking. I also participated in a code on another night where I did chest compressions for only the second time in my life. It was a well orchestrated dance that I felt like at least I knew my own moves instead of being in the way.

The end of orientation is 2 weeks away, but now a definite point on the horizon. Although I'm not looking forward to flying solo the teamwork is incredible and I'm thankful to be working with such nice competent people. 

This quotation fits well with tonight's mood and is one of my little brother's heroes:

"My work is all about adventure and teamwork in some of the most inhospitable jungles, mountains, and deserts on the planet. If you aren't able to look after yourself and each other, then people die" 

- Bear Grylls

So far so good...

This week marks my third week of orientation. It has been a very challenging but enjoyable process. I have encountered very complicated patients and worked diligently to heal and comfort side by side with my preceptors.

A few things that have been of interest in the last 3 weeks:

• Although I am in a medical ICU we are apparently referred to as the CCU (coronary care unit). Why this is no one seems to know. And our surgical ICU is referred to as just the ICU.
• I worked with my first balloon pump. Although I will not have a balloon pump patient for probably 2-3 years (they require specialized training)this was a very interesting experience. We literally did not leave the bedside for 12 hours at a time because it is such a delicate and dangerous piece of equipment.
• I worked with a  Swan Ganz catheter, though not a common piece of equipment anymore, it is still seen in critical care occasionally. This is also a delicate and potentially dangerous piece of equipment, but one that I could be working with in the future. I took my first PAWP (that stands for pulmonary artery wedge pressure), where a balloon on the Swan Ganz cathether is inflated inside the pulmonary artery (the artery with deoxygenated blood that travels from the heart to the lungs to pick up oxygen) to capture the approximate pressure inside the L atrium of the heart. This was a terrifying/thrilling moment in my life crystallized by the fact that I had an audience that included not just my preceptor but a handful of nurses from the unit that wanted to come see a Swan Ganz cath.
• We are the only nurses that get floated outside of the hospital. Apparently if the Meridian St. Luke's is short staffed we can be sent over to help. This is quite different from floating to another unit in the SAME hospital and unfortunately requires a car.
• I completed my second telemetry course. This time it was partially online with the American Heart Association and partially done with a real human being. It was excellent, but also provided a sense of accomplishment because I had real life examples to base my questions on. I also realized that all those squiggly lines have become somewhat second nature to me and the class did not feel overwhelming like the first time.
• I started the ECCO (electronic critical care online) program through the American Association of Critical Care Nurse (AACN). This has been a challenging and rigorous course, but completely applicable to my work. I feel like I am in nursing school again, but at least I get a paycheck with it and a lot less tears ;)
• We are officially moved into our new home! I'm a mile from the hospital, 2 blocks from hiking trails, and 1 mile from downtown. On Saturday I went paddle boarding on the river with a coworker from the SICU and her husband and we finished the day at Boise Fry Company (the yummiest fries I have ever eaten). It felt like a "typical Portland day" and I slept the best sleep I've had in half a year. It was awesome.

Off to unpack some more boxes...

Top 10 favorite things of week one in the MICU

10. The hospital food is edible.

9. The IV pumps are the same as my previous hospital so when they go into a frenzy of beeping I now know how to fix them!

8.I will not develop carpal tunnel because we do paper charting ...and Epic, the electronic charting system, is going to roll out in X number of years.

7. My unit it known for "having all the comedians"

6. The ICU is unlocked - this means families can come and go as they please making the patients and nurses much happier!

5. Nurses get to self schedule!

4. There is soft serve ice cream in the cafeteria for when you have one of the those days.

3. When you admit a patient to the unit there are so many people helping you have to start kicking them out. Seriously!

2. My preceptors are amazing, knowledgeable, supportive, and nice. The staff nurses are inclusive, kind, and have a great sense of humor...and Wednesday nights are waffle nights!

#1. The hospital provides scrubs!!! My laundry basket is both cleaner and lighter!

Orientation: check

First week of general hospital and general nurse orientation is done! The first 2 days consisted of death by PowerPoint - pretty typical of hospital orientations so it seems.

The last 3 days of the week consisted of only nurses-everything from new grads to seasoned veterans. Half of our days were spent doing critical thinking exercises - such as viewing video clips and prioritizing patient care. The second half we reviewed and were checked off in a simulation lab for IV starts, feeding pump manipulations, sterile wound dressing changes, patient controlled analgesia pumps, IV pump management, and restraints. It was actually really nice to know what was expected of us as well as receive pointers from the nurse educators. The nicest thing about a transfer internally though is that the majority of the equipment is the same - I won't have to trouble shoot a new kind of IV pump beeping at me in the middle of the night - it will be the same old one that drives me crazy ;)

Last, but not least, is all the online education modules we have to do as RNs reviewing everything from lab draws, to hanging blood, to managing delirium in the ICU. Again there is some redundancy but it's nice to have access to some newer modules that I had not seen in my previous hospital.

My favorite part of this week was walking through the halls of the hospital when I was in search of a cup of coffee. Large hospitals are like organisms to me and I like to pretend that I am like a little cell roaming the corridors doing my one little job, but that together we are what keeps this giant running 24/7 all year long. All though there is illness inside the walls of the hospital it is also a vibrant, humming place where there is always something going on and there are always people present and busying themselves around the clock running on caffeine, adrenaline, and hope. There is something to that energy that just makes me buzz along and keeps me going for 12 hour shifts.

Monday is learning the charting system, and then Tuesday I'm back on the floor!

Relocation: Boise!

It's officially started: Tomorrow is the start of general orientation at my new hospital (same hospital organization, but new city and bigger hospital). I am soooo incredibly excited and I have big dragon sized butterflies in my stomach all at the same time!

I have my note book ready, my business casual outfit set out for 2 days of boring hospital admin stuff, and then scrubs for 3 days of nurse orientation with simulation! After that who knows what my schedule will bring. Hopefully I'll be moved into our new house by the end of the month too!

A little information about Boise itself for those who are unfamiliar with the area:

• Population: roughly 210,000....the largest city between Portland, Oregon and Salt Lake City, Utah
• Climate: semi-arid climate with 4 distinct seasons....today's weather: high of 94F and low of 64F. 
• Pronunciation: Boy-see....the locals will slap you for saying Boy-zee
• Activities: Boise Downtown (BoDo), Idaho Shakespeare festival (outdoor ampitheater that has plays all summer long), the Boise River for floating/kayaking/rafting, the Boise Foothills for hiking/biking (considered the "foothills of the Rocky Mountains," and Bogus Basin for skiing/snow shoeing

First shift on "availability"

I worked last night, slept wonderfully today, walked the dingoes, made me some dinner and then the hospital staffing office called to tell me I was being placed on "availability" scheduling. I explained that I was in fact scheduled tonight and they said, "nope, not anymore. If we need you, we'll call you and you'll get availability pay." Well that's a new one.

So my cell phone is attached to me and the nearer 1900 is the more guilty I'm feeling for not being at the hospital! I'm terrified at 1915 my charge nurse will call to demand where I am and I'll swear up and down that I was just doing what the hospital staffing office told me to do!

Sleep: a new found hobby and obsession

Last week I worked Tuesday night and had mandatory Wednesday morning education. I took the liberty of grabbing some blankets out of the blanket warmer at 0730 Wednesday morning and finding myself a fold out bed in a patient room in the unused medical behavioral unit that is on the IMCU/ICU floor. I snoozed deeply for one hour and then stumbled back out to grab some breakfast and coffee just before  class. The cook downstairs took pity on me because she made me extra eggs and bacon and kindly suggested I take the BIG cup for my coffee. I definitely got some weird, followed by concerned, looks from my coworkers upon still seeing me on the floor at 0900. I would like to point out I am not the first nurse to sleep in the med behavioral unit and I'm already booking my stay for a few weeks from now when I'll have a repeat of this ridiculous schedule!
The days that I don't sleep enough I end up playing catch up. When I did get to bed on Wednesday I was running on adrenaline I think because my body was compensating and didn't know what else to do! I slept for 3 hours, went to a basketball game with some family members, and then came home and was promptly in bed by 2200 and slept for 12 hours straight. Nothing was going to convince me to get out of bed otherwise.
Being on this night time schedule makes me so much more responsible when it comes to tracking my hours of slumber in an OCD sort of way ;)

All about: PCIs and CEAs

I worked Tuesday night and had class Wednesday morning this week. What an experiment in sleep deprivation and an ode to the powers of caffeine! I had a busy beginning of shift with an immediate transfer of a patient upstairs (a real character and one of those you are always sad to transfer off your floor). My other 2 patients were a carotid endarectomy (CEA) surgery patient and a percutaneous coronary intervention (PCI) patient. So, today I'm going to elaborate on those 2 procedures!

The patients that have CEAs usually have this procedure because they have a high risk of stroke from stenosis (narrowing) of their carotid artery. They may even have had transient ischemic attacks (TIA) which is like a tiny stroke that has self corrected. The CEA patients, when they come from a certain doctor, have the most specific notes I have yet to see. It is very clear about how often neuro checks will be completed (every 15 minutes for 3 hours, every 30 minutes for 3 hours, every 1 hour for 6 hours is usually standard), when to initiate certain drugs if they have certain high or low blood pressure levels, what time to discontinue the antiplatelet IV drugs they are on post surgery, and what time their urinary catheter will come out, even if it's 0300 and the patient is sleeping. Here is a really great video on what occurs during a CEA surgery. In our hospital we use bovine pericardium (the exterior envelope of a cow's heart) to provide a patch.

PCI is very common on our floor. Patients go the the cardiac cath lab, have this procedure where they may or may not have an intervention, like a stent placed. They return to our unit where we check their labs and once their ACT (activated clotting time) is below a certain number we remove the sheath from the femoral artery. Removing a sheath is literally like holding someone's life in your hands. The bandage over the sheath is removed. The suture holding in the sheath is clipped. The arterial pulse is palpated. You attach a syringe to the sheath and withdraw about 5ml of blood. I keep my left hand on the artery just about the sheath entry point, have patient exhale, and then remove the sheath, promptly stacking my right hand on top of my left hand. If everything goes well, you sit there for 20 minutes holding pressure on the site and it coagulates just fine. You clean it and put a transparent bandage over it. Then you patient gets to lie on their back for 4 hours extremely bored so as to make sure the puncture site has plenty of time to start healing. The things that could go wrong with a sheath pull and require you to holler for help:

1. your patient has a vaso-vagal maneuver where their heart rate drops to less than 40 beats per minute and an emergency medication has to be pushed to speed up their heart rate
2. your patient doesn't stop bleeding. You keep holding pressure, you get more people in the room, and you grab a femoral stop device and call the MD
3. the patient has really high blood pressure that's 'fighting' you. In this case some morphine is a great idea because it decreases blood pressure and reduces your patient's discomfort of you pushing on them.

Now here is a great video all about PCI

The Goldilocks' shift and 2 pairs of Danskos (eeek!)

Friday night was awesome. My biggest complaint on night shift has been that it has been too slow. I realize that I sound a bit like Goldilocks- day shift was too crazy busy and night shifts have tended to be too boringly slow. Friday night was my Goldilocks night where everything was just right.

I had 3 patients. I transferred one upstairs, admitted one from the ER, and worked side by side with my favorite doctor who was admittedly looking a lot like a zombie from lack of sleep. My coworkers were a set of ladies I had not worked very much with yet and discovered that together we made a formidable team in the IMCU helping one another out all night. It was great to feel both supported and to know that I was helping my coworkers out equally.

By the time I looked at the clock it was already 0430 and I rushed to finish interpreting cardiac strips, download vital signs, finish noting orders, and be in time for my 0600 meds. By the time I finished giving report and clocked out at 0730 I was running on adrenaline that even after my drive home I was feeling great. The sunshine, that has previously missing from my life for the last 3 months (I didn't see it on day shift either), was glowing in a blue blue sky. We had pumpkin waffles at my in-law's for breakfast and then my darling suggested we drive to Boise for the day to spend our Xmas gift cards.

Much to my delight I got 2 pairs of Danskos - one orange with leaf prints and one dark cherry red (both sparkling). Interestingly enough I found them at two different farming stores. Shopping for Danskos in the middle of cowboy boots is pretty entertaining, but makes sense in the fact that they are all made of leather and last forever. My orange ones were from a little store, Flynn's Saddle Shop of Boise (gift certificate location #1 and they carry the shoes at much lower cost than anywhere else). The staff was super sweet and got me all the size 38s they had available in their small selection. Since Danskos are hand stitched even though the sizes are the same, the fit is not always equal. So after much deliberation I found my 'Cinderella slipper.' Since none of the other 38s fit quite right it was then onto D&B supply to use gift card #2 where I found the dark cherry red pair that remind me of the Wizard of Oz. Although I'll keep my black Danskos on hand, it's nice to feel like I have outgrown them for work!

We ended the delightful day of shopping (don't worry- my hubby got to do his very own shoe shopping with his REI gift card for hiking boots) with dinner with hubby's brother and sister in law and our nieces and drove back under the stars. It was so great to spend time with family, get out of the house, see some sunshine, and then sleep a well deserved 12 hours when I got home.

Prepping for tonight

Tonight I'm flying solo!

I am following one nurse's schedule (my mentor) who is my 'life line' when I need to ask questions, but chances are she will be charging or in ICU so really not that available. Which is a good thing. My "mentorship" lasts a month, but I'm determined to be as independent as within reason and to not let my butterflies get the better of me (my biggest struggle is second guessing myself, which is not the same as asking for a second opinion - patient safety always comes first).

One of my preceptors called me out for saying "I think X...." too much instead of just saying "X is happening." I have been very aware of my use of language since that reprimand in order to portray confidence when I speak - both for my patients sake as well as for avoiding being verbally abused by some of our not so nice MDs. I also happen to be one of those people that apologizes with "I'm sorry" all the time so this exercise has been challenging, but necessary. It feels like I'm faking confidence at the moment, but I suppose the saying is 'fake it until you make it.'

Someday I'll hope to be terrifyingly confident (really it's quite a sight) as the nurses in the ICU that I deeply admire and hope to be as competent as in say...50 years? :)

Today (before I take my afternoon nap) I am cramming in some more of my online ECG class. For non medical people here is a very good, short definition of what ECG is (from: Wiki: Electrocardiography).

Electrocardiography (ECG or EKG from German: Elektrokardiogramm) is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the surface of the skin and recorded by a device external to the body.The recording produced by this noninvasive procedure is termed an electrocardiogram (also ECG or EKG).

An ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker.

I really am enjoying all the education that I am receiving. Each day of ECG classes gives me something new to apply at work. Our unit has large screen monitors scattered throughout the halls with all the unit's patient ECG strips on the screen in real time. So, even if my patients' hearts are normal there is usually something going on that I can practice my ECG 'reading' skills on during the night. 

Back to the books and then time for some napping. 

Also, I included a dingo picture for today because they were being silly.

Mondays are better when they are shared.

Night Shift Narrative

This was my interior monologue in my head last night:

2000: "Sweet I have all my assessments done and my first round of cardiac strips saved and interpreted. Plus my patients and their families are lovely. Boo yah!"

2200: "A family on the unit bought us pizza. One slice is heavenly! Time to get folks tucked in"

2300: "Just got an admit. Easy one at that. Why are they coming to my unit???"

0000: "Must do 2nd assessment and 2nd round of cardiac strips. Some IV antibiotics to hang. Geeze, my eyelids are twitching"

0100: "me so hungry...time for my salad. Gross... too much work to walk down stairs to get something else"

0200: "Just one cup of coffee. Please"

0215: "Omg. Adrenaline rush. That just happened. Time to fix it"

0230: "What the heck! Just gave an awesome SBAR to the hospitalist and I'm pretty sure they didn't even listen to the words coming out of my mouth. I'll follow the new orders, but I'm calling back in an hour because they WON'T work"

0300: "Here we go...."

0330: "Hi. It's me again. That thing you suggested didn't work. Now what? Sweet, thank you."

0400: "Finally....Now I'm awake enough for 3rd assessment and strips. I'll wait for lab to go draw blood and slide in right after them once the patients are awake"

0430: "Hee ha ha - my coworkers and I are hilarious at this time of the morning. We should be comedians!"

0500: "Omg, my eyelids are the weight of bricks"

0600: "Lab results are in, time to get all my electrolytes signed and acted on. A few phone calls to pharmacy should fix my potassiums...So on top of it!"

0700: "So happy to give report!!! Day nurse that arrives 5 minutes early I LOVE you. Plus you had 2 of these patients yesterday - fastest report ever!"

0730: "Time for the window frost scraping party in the parking lot with all the night nurses! And I can't even remember what was so funny at 0430. Probably something dumb."

0830: "In bed. All I can hear are IV pumps and cardiac monitor alarms ringing in my ears....yawn"

First night, flipping, and feline thievery?

My first night shift was Sunday night. I slept in as late as possible....made it to 0800. Walked and brunched with my honey and then around noon took some melatonin and curled up to nap. Around 1430 my husband was in the midst of a home improvement project when a neighbor knocked on the door.

He was thinking perhaps it was a neighbor welcoming us to the neighborhood. In PDX within 2 days of moving into the city of 1 million our neighbors from all sides of our house had welcomed us into the neighborhood and wished us a Merry Christmas. We have been here for a week and a half in a town of 4,000 and it's been radio silence on both sides.

He opened the door and the neighbor inquired if we had stolen her cat. My husband pointed out that there was a cat sitting in the front yard, but that it was there of its own volition. Although she acknowledged that yes the cat in the yard was hers, she did warn that the neighbors on the other side of the house had stolen her cat for several months and that when the cat goes missing she calls the cops to make sure the other neighbors haven't stolen it. My husband reiterated that we have dogs and that her cat was still sitting in the front yard. She went away and left us puzzled about being supposed 'cat burglars' for a cat that wonders the neighborhood freely.

After roughly a 4 hours of intermittent napping I dined and headed into work for the MOST boring shift since I started. Although it was a full moon and we had several sun downers in the IMCU, it was a relatively quite night apart from calming some frayed nerves. I did get the chance to acquaint myself well with my patients' charts and their medical history which was really interesting. However, at 0200, which is about the time I want to curl up under a desk and snooze, I grabbed a cup of coffee and walked a few laps of our unit. Everything went well and when I walked out the door at 0730 it felt surreal to be leaving my unit on time!  I had to wait for my vehicle to thaw for 10 minutes, but then was treated to a drive home with the full moon and the rising sun.

A dingo/husband walk was in order and then I headed to bed until noon. I had to drag myself out from my bed since I return to day classes for the next 2 days. Waking up at noon was akin to torture and I really felt like a 3 year old ready to throw a tantrum when I woke up. My circadian rhythms are going to be confused for the next few months as I will be continuously flipping between nights and days due to my day classes. I did force myself this afternoon to make a hair appointment and a dentist appointment (I successfully chipped a tooth while eating dinner last night and I look like a dandelion with a mullet). I also created the image below to hang on my door.

I have not yet passed verdict on this whole night shift experience since I was told that last night was an exceptionally slow night. I'll be working again Friday night, so we will see how this night owl thing goes... In the meantime, I will beware of wayward cats.

Happy New 2013: car payments and moving!

Yesterday was spent test driving cars. My honey and I have happily lived with only 1 car for the last 5 years. However, since we no longer both work in the same town that was bicycle friendly (like we did in Moscow, Idaho) and we no longer have access to public transportation (like we did in Portland, Oregon), we have come to face the harsh reality of considering a new car purchase. Since I get the commuter car to go the hospital in the next town over this leaves my hubby without a vehicle. This is an issue on weekends especially where he would rather go skiing at Bogus or Brundage while I'm working my 12 hours shifts.

It was snowing and twenty degrees all day yesterday, which meant it the most excellent day to test out the small SUVs that we have in mind. What was even better was that each car salesman was happy to point us in the direction of an especially icy road to show off how great their vehicles handled the snow and ice even without studs on! Having never gone car shopping, this was actually pretty fun! Thanks to consumer reports we narrowed our search down to 6 vehicles to take out for a spin yesterday. This gave us plenty to think about in the coming month as we figure out finances for a new car payment. Ugh!

Meanwhile, we have decided to stay in Buhl. This means we will be moving into a nearby duplex soon once all the repairs are done. I have been so thankful to live with my in-laws, however, I know I become an absolute monster when I switch to night shifts as I demand absolute silence when I sleep during the day. I flip at the end of this month (yessss- no more 5am alarms to get up!) and hoping that we can have our new place arranged and homey by then.

As for today - it's a day to play and enjoy the winter time as we reflect on the year behind us and the year starting.

P.S. For your enjoyment here is a photo of Brisbane enjoying his winter holiday in McCall. He's in a dingo snow hole here.

Week 1: Hospital Orientation (aka Death by PowerPoint)

The moment you have all been waiting for! A work related post and less pattering about small town Southern Idaho.

Well here you have it!

I woke up at 5:00am and got ready to go to work on Mon/Tues/Wed. Since it's general orientation this week I prepped my business casual clothes and headed to the hospital.

Cons of orientation:

• Sitting for 8 hours. Although we did get breaks this was still torture. It was like being in nursing school again! I have a chiropractor appointment to correct that this week.

• People who read off their PowerPoint slides. Yawn!

• We went to the Simulation room to see the mechanical lifts the hospital uses. This was in all reality great, but the initial 3 minutes felt akin to an anxiety attack because I associate Simulation rooms with passing or failing out of nursing school. How unnerving!!!

• My charting program was created before the mouse was invented. Being of the 'point and click' generation this is really foreign to me. I'll get a hang of it eventually, but it feels archaic to me and I look incredibly dumb trying to click on un-clickable items while glaring at the screen.

Pros of orientation:

• I have a name tag that does not say "STUDENT"
• Someone explained the Idaho Nurse Practice Act. Unlike OR and WA, Idaho's Nurse Practice Act is incredibly vague. I was so relieved that the presenter acknowledged the vagueness of the act and clarified what is expected of RNs within the hospital and what we have to do to protect our license.
• I met some of my coworkers from the IMCU/ICU unit. One of my preceptors even started as a new nurse in ICU. It was a relief to know that it's normal to cry every day for the first year (yes, that still stays in the pros column - it's good to know what's the norm).
• Respiratory therapy does everything with tracheotomies and tracheostomy tubes. I don't like trach tubes - I have found the phlegm is one thing I cannot deal with well without turning several shades of purple while trying to maintain a nice smile for my patient. (Non medical people: a hole into the trachea, under the Adam's apple, is called a tracheotomy. The tracheostomy tube is the tube that goes into the hole to keep it open. This procedure and tube provides an airway for people who cannot breathe otherwise.)
• Windows! After having seen some hospitals and long term care facilities lacking natural light, I am a believer that natural light is good for patience and staff. Even cooler is the fact that patients control their own window shades. With the click of a button from the patient bed the curtains go up or down.

• Even Florence Nightengale agrees with me, "I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient."

I'm guessing the next blog entry will be full of unadulterated terror as I probably will come to realize what I have happily/ignorantly signed my self up for as a new nurse. These words come to mind: hysteria, panic, consternation, and distress! 

In the mean time I'm enjoying my last weekend for a very long time. I hope that a year from now I can reread all this and can laugh at myself and reflect on how far I've come.

The truth behind pharmacology

This summarizes why knowing your medications is so important. It is so you can try to avoid this sort of cycle at all costs - both financial and physical- to your patients!!!

This poster was prominently displayed at the clinic I went to last week for my sinusitis and I thought it was really great in that it could foster conversations between patients and health care providers about what needs must be addressed and what preferences can be addressed.

Employee health versus my health

Good news:
I did not pass out while getting my blood draw today! I went to employee health where I was asked about every vaccination I have ever had since birth. I thought I was lucky and only had to get poked for a TB test. Unfortunately though I had to go get a blood draw for a hepatitis titer (for non nurses: this determines your antibody count to see if you are immune to hepatitis, apparently this is routine at my hospital even if one has had all required hepatitis shots).

I am no longer scared of getting shots. I am,however, very against having bodily fluids removed from my blood vessels- not for any religious reasons- only that I become woozy and act like a ninny about it. Last autumn I donated red blood at the Red Cross only to become faint and have the nurses drop my head down and put my legs up and cover me with a blanket (also known as shock position). You can imagine how thankful I was to not have a repeat performance of that event today. I had a vision of the phlebotomist running down the hall to the ICU to tell them what a silly fainting new nurse they had hired fresh out of nursing school. It could have been incredibly embarrassing!

Bad news:
I seem to have a terribly weak immune system. Moving from Portland to here I had a stressed induced cold. It was an awful bug that had me running on empty for about 2 weeks. After avoiding dairy, meat, and wheat I perked up just in time for Thanksgiving when I got to cuddle with my little nieces (aka as adorable pietri dishes with legs). Alas, I got my very own version of the preschool plague. My goal is to be better my Monday for my first day of orientation.

Achoo!