Thursday, August 30, 2007

Back to School

This week I spent most of my time and money getting my kids ready for school. I won't say how much money I spent, but I am broke as hell. Who could have thought that crayons and notebooks and other miscellaneous crap, (that the schools will be asking for more of by December), could cost so much money? Oh well, my kids don't need to ask me for nothing else for a very, very long time. Besides, they aren't the only ones returning to school. I am too.

The DiVa is returning to school to finish her master's degree and eventually my PhD full time. This semester I am registered for 9 credit hours. Thank God I don't have to work. That's right, I don't have to work. My former university loves me so much, they are paying my entire tuition, books, miscellaneous fees and they are giving me a monthly stipend for my living expenses. This is a huge blessing. I have to take back everything negative I ever said about my school. They believe in me, even though they have the strangest ways of showing it. NurseDiVa, the professional scholar.

So in order to accomplish all this, I had to quit my job. Just as I started to really know what I am doing, I am leaving. I have mixed emotions about leaving the job, mainly because I feel I am losing my sense of security. There is something about relying on someone else for financial security that just makes me cringe. Secondly, I kind of feel like I gave up. Well, I didn't give up I got a better offer. I also take issue with the concept of becoming an advanced practice nurse with only one year of nursing experience. I will find something PRN to keep me busy in the meantime, but I can't imagine working more than 5 days a month. Mainly because I will need to have time to spend with my children.

I am just beaming with joy and pride that I didn't let this crazy job beat me. I still have another week to work until I start classes, but everyone knows that I am leaving. I will actually miss the job. I am also worried that the patients who are mainly minorities are losing one of their best advocates. I imagine that someone else will come along and take care of them, but I still worry a little. My mother is so ecstatic. She has called everyone in the family and told them I am going back to school. I am excited to have a life again. If school is the only thing I have to do, I might actually get to have a life with friends and family. More importantly, I have some huge shoes to fill. Right now, I have a lot of people looking up to me that will kill me if I let them down. They have nothing to worry about, I am going to be the best damned nurse practitioner/educator ever!

The future Dr. NurseDiVa...sort of has a ring to it, don't ya think?

Monday, August 20, 2007

Today is my puppy's birthday...

He is one year old today. I can't believe he made it. I never had a pet as a kid. Only a goldfish and of course goldfish don't require a whole lot. I must say, having a puppy is like bringing a new baby home. He still isn't potty trained. But in October, he will get it together because I will have the time to teach him.

I want to give him a little party. There is a pet store where we live that makes puppy cakes, maybe I'll buy him one of those. And the kids can make him a nice dinner of Purina one and mighty dog beef dinner. It should be pretty fun. Maybe I'll invite the neighbor kids and put some hot dogs on the grill. I am so excited!

DiVa...Now why does a dog need a birthday party?

Saturday, August 18, 2007

The REAL reason why there is a nursing shortage...

Being a nurse is a stone cold trip. If you choose not to "play the game" one can easily end up on the shit end of the stick. And in all fairness, I think that applies to all nurses regardless of color. But if you are reading this and you are a minority nurse, I think you know what I mean. I first noticed it in nursing school. It started with little nuances that are designed to weed out those who they "think" aren't going to make it. Most of the time, my school worked with me and my family situation. But there were those occasions when it became clear to me that they really didn't care about me or my family situation and that I needed to make a choice between being a mother or a nurse. While that is clearly not a choice I decided that I needed to see this thing through because I knew that if I quit nursing school it would be impossible to find a job to pay that private college tuition that was accruing with the federal government. Despite my family problems I had a solid GPA that was a true indication of my talent and drive to be a nurse. Don't misunderstand, nursing is my passion. I didn't get into it for superficial reasons like money or power, I love taking care of people.

I thought it would be different once I became a bonafide registered nurse. Think again. In the workplace, I have noticed that I get special attention that other nurses tend not to get. Even other new nurses. I am a new nurse, but a competent nurse. I noticed that if I ask a question, I get snubbed because perhaps maybe it is a question that people think I should know the answer. But if I don't ask a question and there is a marginal outcome, I am held accountable. I don't have a problem with being accountable at all. If I made a mistake I own it just as well as I own the things about my performance that I am proud of, it is part of my growth as a human being and an example of the splendid person that God created. I love my mistakes and great accomplishments, but damn! Is it a learning opportunity for EVERYONE? It is discussed in the conference room, in the break room, at the nurses station...wherever. And without regard to my feelings or need to have a healthy self esteem as a nurse. Sometimes, before I even have an opportunity to ask for help, I will turn around and there is a room full of nurses, which can be a good thing. At first this was a welcome sight because I knew that someone had my back. That was until I got called into the office about my performance. I talked to the charge nurse and she told me to politely ask people to leave if they come into my room on some bullshit. I can't tell whether or not it is bullshit or sincere help so I am a little cautious, which can be both to my benefit and/or my detriment. I was warned that one day I will call for help and no one will come. If that shit happens, I guarantee that I will not be the only one in trouble.

In my culture, you are to demand respect from others. That's how it is. Watch your mouth when you talk to me, treat me with the same respect that I treat you with. Or else. I do NOT kiss ass. Let me say it again, I DO NOT KISS ASS. I feel like I am just as good as anyone else. I am not going to sit around and gossip to the others about you. I will tell you to your face. The next day, I will still treat you with respect because that's how I am. Not at my job. One day I talked to someone about something that they did that I didn't like and she was so nasty, you would have thought that I had disrespected her. I followed the proper format too! You know the one that goes, "I didn't like it when you _______. It made me feel like_______, and I would appreciate it if in the future you would ________." There is no good way to give a nurse feedback. It is always misconstrued. Maybe I should try a different approach like, "I think you are a great nurse, ______. I respect your expertise and admire your style. But, it really bothered me when you _________. It made me feel like _________. I really want us to have a good working relationship. I would like it better if you ________. I hope you don't take this the wrong way. I truly value your friendship." Hell no, that is kissing ass. And besides, people aren't that nice to me. They will tell me off in front of anybody. The doctors, the patients, other nurses...whomever is present. But if I do it, no matter how I do it, I am defensive and mean. Ah, whatever. Sometimes you have the be the bigger person. But must DiVa always be the bigger person, taking the high road?

And the saddest part of all is that there are two other nurses that belong to my ethnic group, both more senior and more experienced that me. One is very helpful. The other treats me like crap. If the roles were reversed, no one could say shit about either of them in my presence. I would defend them to the end. The more senior of them has done everything possible to help me in my troubles as a new nurse. Without her help, I would not have made it as far as I have. And I understand that there are limits to the help she can give me without compromising her position. People respect her opinion and she is the one thing that keeps our unit afloat. Without her, our floor would be crap and everyone knows it. I can only hope that one day I can be as good a nurse as she. The other, she's in with the clique of nurses who sit upon the throne of nursing goodness and cast stones at those who choose not to participate in their brand of ostracism. I guess she really needs to be a part of their group, being snobby to others. She is so nasty to me that I have stopped speaking first. In my culture, if you see someone first, you are supposed to say "Hello." It's just one of those things my grandma taught me when I was little. There have been times that I have spoken to her and she acted as if I was invisible. I talked to her once and asked her what I ever did to her. She couldn't pinpoint anything. I told her that she wasn't a very nice person. She didn't sound surprised. She was nicer for a couple days and returned to being bitchy. Oh, and then there was that one day she implied that I was a bad mother because I don't allow my son to operate the lawn mower unsupervised. That isn't a very big deal, but it still pissed me off. It is clear that she thinks that she is better than me because she grew up in the suburbs and had the finer things in life. I learned something a long time ago that I take to work with me everyday. The worst possible situation that a person could have could easily happen to you. Never think of yourself as better than someone else just because you have more education, or money or more anything. You never know where you will end up. All that ass kissing that she does must pay off because people don't mess with her like they mess with me. The absolutely LOVE her.

The clique. I have found that if this group of nurses spend all their time pointing out the flaws of other nurses, then no one will notice that they aren't that great begin with. I imagine that they treat me like that because I choose not to hang out with them or attend their parties or say anything negative about other people. I can't trust bitches like that because if they will talk bad about others, they will talk bad about me and I don't play that. I don't tell them my business. They don't need to know nothing about me. In a way, I wish I could have friends at work but a the same time with friends like that, who needs enemies? This sort of behavior is not exclusive to the nurses on my floor. Doctors can be just as bad.

It seems to me that if there is a possibility that a situation that might have an unfavorable outcome, the doctor will find some way to make it a nursing issue. I cannot write prescriptions. I have not reached a level of expertise where I can question a doctor's judgement. Nor can I make any suggestions regarding the plan of care. I can only voice my concerns and document interventions the rest is up to the doctor. Twice in my short career has a doctor tried to shift the blame of a situation that had been going on ALL DAY on me. They need to settle the feud between them and family practice and find a way to work more cooperatively. Otherwise, family practice physicians should not do OB. Period. We are all on the same team. I strongly feel that medicine is a collaborative process. It is not us against them.

Whine, bitch, moan. Oh DiVa, you are the perpetual victim. This is my blog and I can talk about whatever I want but damn, wouldn't it be nice to hear me speak of my glowing experiences as a nurse. Wouldn't it? I am always doom and gloom. I have had a few nice deliveries, but it is always foreshadowed with drama. I am still wondering when I will be treated with the same respect and professional courtesy that I treat others with. I could always quit this job. believe me, I have had offers, but at the same time I feel compelled to stay. Maybe it is because I refuse to let this job beat me. Or that I feel like the patients need at least one nurse that really cares. Call me crazy. I guess I can control the stuff I write about, but in all reality, I don't have anyone to talk to about the stuff I experience as a nurse. No one that would understand anyway. I am sure y'all don't mind. I heard that it is like that everywhere. Can this be true?

DiVa...trying to make the best of a bad situation.

Addendum: I didn't even mention the long hours, low pay, lack of time for family/household responsibilities, huge workload and lack of recognition for service.

Saturday, August 11, 2007

Who does she think she's talking to?

I was taking care of a patient who was having twins and singleton patient. One in active labor, the other a pitocin induction. My twins mother was a primipara pitocin induction, but I hadn't started the pitocin yet because she was contracting just fine. Her blood pressures were higher than normal and since she was a G5P0, I had the doctor review her pressures and labs were ordered to check her for preeclampsia. The other was a multiparous patient who was real uncomfortable. Nurse B was in the same nurses station taking care of a chronically hypertensive mother on hydralazine because her pressures were sky high. The shift had just started. I hung my medication for the twin mother when I happened to look up at my singleton mother and noticed that her tracing was looking kind of strange. I went to visit my singleton mother and she was looking like her butt was about to explode. So I put on a sterile glove to check her and the baby was crowning. I run to the intercom and call for assistance immediately. No one came. So then I ran out to the desk and called two more times. Finally many people come into the room and the mother pushed out a healthy baby boy. In the meantime, Nurse B took care of my patient. I gave Nurse B a quick report and she watched my patient for two hours.

During that time, Nurse B knew the situation with the elevated pressures on the twin mother. She knew that labs were ordered, she didn't draw them because her tracing was bad on her chronic hypertension mother. I didn't hold it against her because I knew she had the more difficult patient. As soon as I finished my delivery, I got all of the charting caught up and got the labs together to assess her elevated pressures. Nurse B was aware. The whole time I took care of my twins, the mother was throwing up, violently. Her labs came back normal and the MDs decided not to treat her with magnesium sulfate. Despite all that, I had a foley placed for her comfort. In the meantime, I talked to Nurse B and we were having a pretty nice time working to gether. Her chronic hypertension mother delivered vaginally, which was quite a feat considering her tracing and all the drama with the Doula. During her delivery, I got a new patient that was Spanish speaking and 6cm dilated. Not a problem for the DiVa because I speak Spanish. I knew this patient was going to go very quickly and it was no suprise when she was completely dilated within two hours of being brought to the room. By that time Nurse B finished her recovery and had to take over my twins...Again! Let me put emphasis on AGAIN.

The tracing for my spanish speaker was not looking good and it was time to push. Nurse B asked me who was watching the twins. Obviously, no one because all this happened rather quickly. She was done with her delivery so she knew that she was going to be watching her again. We are holding legs and pushing with my mother when she says something like, "So are you gonna give me report?" Meanwhile the chief resident is yelling at me and the first year like we were idiots. This is amazing to me because the chief was quite inept just last year and now she is shot callin like she really knows what time it is. Any reasonable human being could see that it was an inappropriate time to ask for report because I am running crowd control, trying to find a fetal heartrate, keeping the mother calm, trying to remember how to conjugate Spanish verbs and accomodating doctor's requests. I ignore Nurse B and give all of my attention to the delivery. The baby comes out limp, purple and barely breathing. I am FREAKING out. I run the baby over to the warmer and call out for the charge nurse. I run back over to the warmer and rub the baby really hard. I bag for a few seconds so that the baby has a little extra oxygen before I start suctioning.

Just as I am doing that the charge nurse turns the corner and of course the baby is crying. He's juicy, but crying which is a good thing. The charge nurse says, "You're alright and if you need help just call Nurse B." So once the baby starts crying the requests start rolling in, "I need Vicryl." "I need lidocaine." "I need more lidocaine." Here comes Nurse B, "Are the doctors aware of her blood pressures?" She knows about this patient, at least as much as I know so why is she asking me these stupid questions?

Wednesday, August 01, 2007

I'm a NurseDiva, even at home!

As you know I am a DiVa and a Mom. I love being both but sometimes, I like to leave the NurseDiva at work. When I work, my FOB watches the kids. It's free and Hell, it's his responsibility. So Saturday morning, when I came home to find him passed out on my couch my nursing super-powers began to tingle. When I finally woke his dumb ass up I asked him what was wrong. He said something like, "I am having the worst headache of my life." I was thinking, Damn, I haven't got that life insurance policy, yet...this bastard better not stroke out in my living room!"

I will be back to tell you what happened next after I take my son to his physical.


Alright I am back. Where was I? Oh yeah, so my FOB was having the worst headache of his life and I was regretting not having gotten that life insurance policy. I told him to get up right now and go to the hospital. I went with him and when we arrived I said a phrase that I knew would get him a room immediately. I said, "I think he's having a stroke." So they did the "hold your hands out" and "smile" tests. He passed. They asked me why I thought he might be having a stroke and I told them about his headache. They tried to take his blood pressure and it was unmeasurable. So then they take him to a trauma bay and hook him up to the monitor. His blood pressure still wouldn't register. So they keep trying and finally a blood pressure of 248/161 came up. Amazingly, they did not panic.

They tried to start an IV and had problems gaining IV access. I volunteered to help and we found access. Then they gave him medications in his IV. He got 60mg of labetalol and even after that his pressure was 199/136. I am freaking out and somewhat regretting my decision not to take him to the county hospital, but at the same time I didn't want him to code in my car. Long story short, they kept him in the hospital for three days and discharged him. Do you think he so much as thanked me for my help? Not him. I was almost having a moment of weakness, until he got smart. I should have let his ass have that stroke he was trying so hard to have. But I was trying to help. He is so goofy. Right now, he hasn't eaten anything because he is on a 1500mg sodium diet and he has no idea what he can eat. I would help him, but he has an attitude. For all I care, he can eat salad everyday. I am half tempted to order his favorite pizza with pepperoni, sausage and bacon and leave it on the counter steaming hot and cheesy...

But you know I am not going to do that. I will be nice and grill him a piece of chicken and steam some rice and vegetable. I might even measure the correct proportions so that he doesn't overeat. Hold on. He doesn't live here. He better pack a lunch!

DiVa...letting a grown man be a grown man for a change!