Thursday, October 26, 2006

A moment of self doubt...

Business

Gosh, no one ever told me that being a nurse made you go through so many changes as a human being. I go from feeling really confident to being afraid to touch another patient to just being a raving lunatic. Mixed emotions isn't even what I would call this, it is pure insanity. I am a good nurse, I know I am, but when something goes wrong, I find myself reviewing my actions and wondering what I could have done to change the outcome from a retrospective point of view. I have been trained, I know what I am supposed to do. Comfortable, I am not. In a way I don't ever want to be comfortable, I always want to have that little feeling of "What if?"

You know like, "What if my patient codes? Then what am I gonna do?" I want my response to a crisis situation to be a reflex. A knee jerk response. I am still waiting for that to happen. Alarms are constantly going off on my unit, but I need to train my ear for the alarm that means something bad is happening. My skills are tight, I can IV and foley with the best of the best. Everything else crisis oriented, I just feel frozen. And when I do move, I am a tongue-tied, bumbling idiot. I know what to do, but I don't know what to do first. Right now I am going to treat everything like an emergency, at least until I am able to discern a TRUE emergency. I have to learn when I can be therapeutic and when I need to be stern to a patient and tell them what they need to do to prevent a terrible outcome.

I was told by a seasoned nurse that it will be at least a year before I really feel like I know what I am doing but in the meantime, I feel like a total liability. I am being told that I am doing well. I know that I have horrifically low self esteem and that I can't take a compliment, but I just don't feel right. I need to do something extraordinarily good...Soon or I am thinking about getting a job in a doctor's office where the extent of my responsibility is taking vitals and telling people to change into a gown and pee into a cup. But I bet that people code there too. I just have to find my zone. And being the Diva that I am, it won't be long before I fond it.

Personal

The kids are well. My brother came home for a brief visit from the Marines, then he was shipped to Japan. I guess that is better than the Middle East, but I will miss him and worry about him just the same. My mother had a biopsy done recently. For the past few years she has been complaining about this pain in her left arm. Most recently she told me that she has had discharge coming from her breast. This finding concerns me as my mother is post menopausal. I hope that she will be well. The thing that bothers me the most is that she was not forthcoming about her condition to my brothers. In the worst case scenario, I think I would have liked them to know what is going on with her. My Dad, he is a complete wreck. He is a jerk, but he cannot live without my mother. I am praying that everything is going to be okay.

DiVa...Someone, anyone holla if ya hear me! Throw me a life vest, I am DROWNING out here!

Sunday, October 22, 2006

Musings from my inbox...

Why I love my Mom...




Mom and Dad were watching TV when Mom said, "I'm tired, and it's
getting
late. I think I'll go to bed."


She went to the kitchen to make sandwiches for the next day's lunches.



Rinsed out the popcorn bowls, took meat out of the freezer for supper
the following evening, checked the cereal box levels, filled the sugar
container, put spoons and bowls on the table and started the coffee
pot
for brewing the next morning.



She then put some wet clothes in the dryer, put a load of clothes into
the washer, ironed a shirt and secured a loose button!

She picked up the game pieces left on the table, put the phone back on
the charger and put the telephone book into the drawer.

She watered the plants, emptied a wastebasket and hung up a towel to
dry.

She yawned and stretched and headed for the bedroom. She stopped by
the
desk and wrote a note to the teacher, counted out some cash for the
field trip, and pulled a text book out from hiding under the chair.

She signed a birthday card for a friend, addressed and stamped the
envelope and wrote a quick note for the grocery store. She put both
near
her purse.

Mom then washed her face with 3 in 1 cleanser, put on her Night
solution
& age fighting moisturizer, brushed and flossed her teeth and filed
her
nails.

Dad called out, "I thought you were going to bed."

"I'm on my way," she said.

She put some water into the dog's dish and put the cat outside, then
made sure the doors were locked and the patio light was on.

She looked in on each of the kids and turned out their bedside lamps
and
TV's, hung up a shirt, threw some dirty socks into the hamper, and had
a
brief conversation with the one up still doing homework.


In her own room, she set the alarm; laid out clothing for the next
day,
straightened up the shoe rack. She added three things to her 6 most
important things to do list. She said her prayers, and visualized the
accomplishment of her goals.

About that time, Dad turned off the TV and announced to no one in
particular. "I'm going to bed."

And he did...without another thought.

Anything extraordinary here? Wonder why women live longer...?

CAUSE WE ARE MADE FOR THE LONG HAUL .... and we can't die sooner, we
still have things to do!

Send this to five phenomenal women today...I just did!

Then: GO TO BED!

Monday, October 16, 2006

My first incident report

Last week I had a little problem.

I work nights and on this particular night, I didn't get the rest that I am used to getting. I came into work, not feeling like I was going to have an great night. I had a choice of patients. The other more experienced yet still new "graduating in the top 5% of her nursing class" nurse said she didn't want the patient that I was getting because of her "poopy tracing" and God forbid she should get stuck with a potential crash. (Serves her right because her patient had an even "more poopier" tracing than mine!) I got report and coming in, this patient had already had one late deceleration on her tracing, which in my line of work is indicative of a non-reassuring fetal status. Also the baby had passed meconium that some consider to be indicator of non reassuring fetal status, (or possibly a mature digestive system, we are still waiting for the evidenced based explanation). Another way to say non-reassuring fetal status is fetal distress, but we NEVER say fetal distress because attorneys have a field day with that sort of thing in the event of a deposition.

So, her labor wasn't progressing. She had been 6 centimeters for almost 4 hours which can be considered arrest of labor and lead to a c-section. So it was my responsibility to increase her pitocin. The therapeutic benefit of pitocin is to generate contractions that dilate the cervix and facilitate the descent of the fetus into the birth canal creating a situation conducive to vaginal delivery. I followed the protocol, I assessed the fetal heart rate, I assessed the intensity and regularity of the contractions. The contraction pattern was irregular and non-functional, which justified my actions. The baby's heart rate indicated that he was tolerating the labor well. The patient's lungs were clear to auscultation and her blood pressure was within normal limits.

Our protocol is to increase the pitocin 1-2 milliunits every 15 minutes to a max dose of 36 milliunits per hour. At the time she was at 14 milliunits or 28 ml/hour based on the dilution of the medication in normal saline. My intention was to set the pump at 30ml/hour or 15 milliunits. The family was talking to me, the room wasn't lit very well and somehow I set the pump for 90ml/hour or 45 milliunits/hour. I walked out of the room to get ice chips for the patient. She had an epidural, so she wasn't giving me that "Oooo" that lets me know I did something wrong. It ran at the wrong rate for about 5 minutes when I noticed it and immediately changed it. I came out and told one of my nursing colleagues and she said note the chart of your error and monitor the patient. For 45 minutes nothing happened. Everything was normal.

Then the doctor went in to do a vaginal exam. All of the sudden, I looked at the tracing and noticed that the baby was having a little decel. I thought that the monitor came off so I went into the room to see what was going on. The patient was on an internal monitor. This decel was REAL! I was freaking out inside. I turned the patient from side to side and gave her oxygen. IT DIDN'T COME UP. The heart rate was 59 bpm. The doctor was still at the bedside. They gave her medication to stop the contractions and we turned off the pitocin. The heart rate finally came back up. Whew! I told the doctor of my error.

In that moment I was embarrassed because when something is going on everyone is listening and looking at YOU. Every doctor on the floor and ever available nurse was there. This is good because if you need help there is someone there. At the same time you kind of feel bad. If there was a bad outcome, it can be neither confirmed nor denied that it was a direct result of my wrong doing. I filled out an incident report. For the rest of the night I didn't want to touch her medications. Then the doctor said that I needed to give her more pitocin so that the patient could have contractions because her labor pretty much stopped. I did, but I was scared to death. I especially hate the fact that everyone knew about my mistake. I was the talk of the unit. I am sure everyone has made a mistake. Mine was minor, but I will have my eyes open from now on. Maybe someone will learn from it making my public humiliation worthwhile.

After that, one of the older 20 year veteran nurses walked me through each medication adjustment, which made me feel much better. The patient dilated to 10 centimeters and 100% effacement at the end of my shift. I imagine she delivered without too much trouble, except the fever that required antibiotics.

DiVa...Feeling not so confident but thankful for the angel over her shoulder!

Thursday, October 12, 2006

Three days in a row...

And I don't have to work. Working is fun, but hanging out with my kids is funner. English skills declining. Need sleep. But adjusting to this nursing thing okay. Work is still fun.

Okay some weird stuff going on at the job. About 10 nurses quit recently. Makes me wonder what I have gotten myself into now. I am one of 5 new nurses on the floor, and one of three new grads. There are three new hires who haven't started yet are also new grads. Interesting no? And we will all work the same shift. Nights. We have a really great charge nurse who we affectionately call Abuelita. Abuelita has been a nurse for almost 30 years. She is really great. She knows what is going on all over the unit at all times. She is my role model.

We have a guy nurse that works in our unit. He is probably one of my favorite nurses. Anyway he was a little hyper about an alternative lifestyle couple that came in recently. Okay he was a little more than hyper and a lot of the girls on the floor were discussing his behavior. It made me realize something. If someone has it out for you, they can make your life a living hell. They ganged up and reported his behavior to the nurse manager. I think that someone should have talked to him first or the nurse manager should have handled the situation. They didn't, they went directly to the nurse manager. Ouch! When you make a mistake on my unit the whole world knows about it. I know I will make a mistake, but I wonder what it will be like to face my peers afterwards.

The other night I was about to have dinner with my kids when I got called into work. My kids were crying. I felt really bad because I had slept all day and spent no time with them. I really have to start making myself get up in the afternoons with the kids and hanging out. Well, time to get the kids ready for school...

DiVa...Starting to get the hang of this nursing thing!

Sunday, October 08, 2006

A stellar first week!

This was my first full week out of orientation and I think I was alright. I still don't feel as comfortable as I would like to about reading the fetal heart rate tracings, but I know what a late decel looks like and I know what a deep prolonged variable looks like. If you struggle with fetal heart tracing here's a few links to give you an idea of what I am talking about

http://www.aafp.org/afp/990501ap/2487.html

http://www.obfocus.com/cme/fhr.htm

I will be spending some spare time studying. My days and nights are all confused like a baby. I stay up all night long, even on my days off and I sleep all day. I am still losing weight. Nursing is a very physical activity, I have built muscle and endurance from breathing with the patients and running back and forth to hike the pitocin. I find that I only really like to increase my pitocin when the patient has an epidural or when the patient has a good contraction pattern where I can see resting uterine tone in between contractions. Otherwise I need an internal monitor to assess the strength of contractions. I like to keep my patients comfortable and happy. I wonder how long I can keep this energy going.

As a new nurse I am so therapeutic. I imagine it must be sickening to my peers, but my patients like it. I wonder what I'll be like in a few years. Will I still go to work everyday with a smile on my face and a bounce in my step? Last night, one of my fellow nurses was being a little mean to one of the laboring patients. I felt sorry for the family because there really wasn't a good reason for her to be mean. She has only been out of orientation for five months and she is already disenchanted. This woman is the same lady who when asked how she felt about adjusting to her new role as a nurse said "I graduated in the top 5% of my class and I know that the knowledge is there, but everyday I feel like I am learning something new and with every challenge my confidence increases. I love my job and can't imagine working anywhere else." In addition, she passed on the legacy of the mean with the report she gave to the next shift. When I am in report and people say that someone a patient is an ass, I try to develop my own opinion.I try to find out why a person is angry. I dunno...

DiVa...Taking good care of my patients is part of the job!

Tuesday, October 03, 2006

Tonight's the night...

Foreword
To everyone:

Thanks for stopping by, I am so happy to hear that my stories of triumph and (sometimes) defeat are inspiring. As I was going along my journey to professional nurse-dom, I often wondered if I was the only one going through some of the things I experienced. Thanks to all for your continued support and I wish you all the best of luck in your careers. You are always welcome to leave a comment or ask a question.

DiVa


And now today's news...

Tonight is my first night on my own as a labor and delivery nurse. I am scared and excited all at the same time. I am trying to do as much of my stuff for my kids' morning routine tonight before I go in to work. I live about and hour away from my job so I will be leaving shortly.

I received my student loan paperwork today and my monthly payment for my loans is $337.00 and that is not including at least two of my loans. I am out of grace in November. (Sigh...) I figured out when my loans would be completely paid off and realized that I will be 59 years old. 59 YEARS OLD! Damn. I will be eligible for retirement by the time my loans are paid off. The total amount of my loans, provided that I pay them according to the terms is $82,000. Imagine what student loans are like for doctors! If I were a professional athlete, I would make enough money in half a year to pay my loans off entirely. The priorities of our society are all jacked up!

To add insult to injury, I received my son's interim report and his grades are terrible. My old car pooped out on me and I had to buy a new one. I love my car, but my payments are going to KILL me. When it rains it pours. I am going to apply for this government program that will help me to pay off my student loans through HRSA and if I am approved I can get 60% of my loans paid. Light at the end of the tunnel. Okay, my daughter wants some attention so I gotta go.

DiVa...Wishing that she was independently wealthy!