Holy F!

an update, if you care

I've decided to use this as sort of the actual blog...cause it's cooler than myspace...I guess.

So I kind of love Sara Ramirez singing on the Spamalot soundtrack...fyi.

I am down to three weeks to go for my internship and I have days when I am totally sure that I'll be okay when I'm on my own. Days like Wednesday and Thursday, when I have my patients who are sick and have problems, but are more or less stable.

I also have days like yesterday when I am given what was a resonable assignment at 0600, but by 0715 when one patient has coded twice in the last hour and I subsequently spend the next 12 hours of the day exclusively in that room save for using the bathroom and the half hour or so when I am uncerimoniously escorted out of the room for lunch at 1630 (in defense of my preceptor, I was offered to go to lunch much earlier but the offer was something like "you can go to lunch now, I've got it, but they're going to float the Swan-Ganz catheter in now, so you can go eat, or help with the Swan...it's up to you"...I picked the Swan placement.) ...those are the days when I have this little mantra in my head that I repeat over and over that goes something along these lines "they WON'T let me kill someone...they WON'T let me kill someone...they WON'T let me kill someone..."

I've had more good days than bad, for sure...but it seems like I get one of THOSE days every week...a day when I end up spending the whole day in one room with a majorly critical patient wondering "why on earth did they give this patient to ME????? Do the other orientees get self inflicted, donor GSW's also? Do they also get the patient who spontaneously ruptures their spleen????...F" (as far as the spleen goes...the team leaders didn't know at the time of making assignments that that would happen...the guy next door had a Swan they wanted me to see; too bad I never made it into his room at all...whoops.)

I keep telling myself that I really won't have those patients from the start if they can at all help it. But then I think "well, I'm going to have to get those patients eventually...when will I know if I can do it if I don't get the patients..." I mean, this isn't like most entry level right out of college jobs...I'm not making budget reports or faxing memos (although I do fax orders) or just making presentations...these are critically ill patients. Some of them have died on me (two!!!) and a lot of them have certainly had the potential. It's not like the learning curve is dealing with paper work or presentations, and it's not like the learning curve contains difficult INFORMATION...I'm picking stuff up and trying to read as much as I can and listening to what the docs are saying...it's just that my learning curve is in the middle of life and death situations and once it's my patient...I'm sort of in charge of what goes on in my rooms...which is a little scary. I can tell the docs "no, not gonna do that..." and then I have to give them a reason and then sometimes they listen to me! I think I've had a healthy respect and fear for the situations I'm putting myself into right out of school; I knew this was going to be hard and I knew the learning curve would be steep and I knew this would be a big mental and emotional challenge, but I think that the closer I get to being on my own, the more I'm REALLY REALLY getting it. I'm the last line of defense for some of these patients. It's sort of scary.

I was the one in the room yesterday while the docs put in chest tubes...ME. They asked ME for things and I assisted with the procedure...it was very cool and very surreal. I wonder when that gets less weird. I had to stop myself from doing a dance after the attending said "Thanks Nicole" and then gave me orders for labs...it was all very grown up.

Last week we got a really nice kid in and his family was great...scared but great. Mom poked her head out while I was in the other room and told my preceptor "well, I was looking for Nicole since she's his actual nurse..." Whoa!!!!!!!! When we were transferring him to the floor (yay!!!! he was VERY bueno) she told me "I'm glad we're getting out of here...We love you, but I'm glad he's getting out of ICU". My ego just loves getting stroked like that!

Oh, and I really didn't realize this...when an adolescent gets in a traumatic accident...Cook Children's doesn't take them. Apparently the rule is that if they have facial and/or pubic hair then they come to my hospital. I think that is kind of suprising. I would think that Childrens would mean "anyone who sees a pediatrician ie, anyone under 18". Guess not! Hmmm, maybe we should also get donations from people wanting to help Children since we get patients from puberty up. Greedy girl. I also didn't really realize how fast our ER is. When they say "we stabilize and transfer", they REALLY mean it. A few of the trauma's I've gotten, I think their door to ICU time is less than 20 minutes. Quick assessment in the ER, CT and up stairs...When you get report, you best be ready cause they aren't kidding with they say "I'll see you in a few minutes" cause CT takes about 5 minutes when you don't have those stupid IV poles to worry about!

I'm on days this last week and then next week I switch to night shift...I'm pretty excited about the money! Like I said...Greedy girl.

I looked at some houses last weekend...two are very real possibilities. I'm going to look back at one hopefully sometime this week. I'm kind of hoping to find something and close sometime in December...taxes and all! Plus, I'm ready for it. I'm ready to finally be a real adult and pay my own way (now that I have a good job where I can actually afford it!) and do grownup things like paint (!!) and buy chair railing, which I hope is cheap.

I saw my neice last night. She is still freakin' adorable. I didn't get any new pictures though. I suck. We did however discuss football and how to put in chest tubes and the importance of deflating the balloon when floating a Swan and what wedge pressures REALLY mean to her.

Getting there

So I'm four weeks through my internship and time on the floor with a preceptor...four weeks to go. The big halfway point. I'm taking two patients pretty much every shift and doing pretty much everything for them. So far, so good!

I've had two days where I felt VERY unprepared...one in which I took patients and just had a long hard day getting things done because my preceptor was off in another crisis and one where our patient WAS the crisis and I was entirely too unprepared to do anything.

But...it's getting better. Friday I had two patients...one very busy and one not so busy and I think I did okay. I got my meds passed and orders received and all those good things.

I know that when I get off orientation I'll get the lower acuity patients, which is a good thing. I can handle the tough ones...but not two of them and not one hard and one easy...the one hard gets too busy and I put my blinders on and can only focus on the one thing for right now. I'm getting better though.

I'm definitly starting to feel like a nurse though. I'm assisting doctors in procedures, I'm pulling the drugs and notifying doctors of things that concern me and I'm learning what is concerning and what isn't and when you get VERY concerned.

Plus...I still kinda love my job!

Ready, Set, NURSE!!!

No one reads this, and I haven't updated in awhile, but thats okay. I still like it! Maybe someday someone will read it. I just really can't decide how public I want to make it...the more public it is, the more trouble I could cause!!!!

So I finally get to put my hands on a patient next week. I haven't touched a patient since July! After four long weeks of orientation stuff, hospital and unit, I am READY. Not necessarily completely prepared, but I'm definitely ready to get the first week over with. I'm so used to being in the "student" role and being able to say "I'm just the student, I don't know, let me ask my nurse/teacher/etc" or preparing my meds with someone watching me and making sure I don't totally f up and now...I'M the nurse. I don't have "I'm just the student" to fall back on and I can't go ask my nurse and there won't be anyone watching out for me...I AM the nurse. It's a strange transition to have to make and I'm kind of nervous about it!

I wonder how fast I'll get over the learning curve and how quickly I'll be able to confidently care for my patients. I like to pretend that my ego doesn't need stroking...but in this case, when all of a sudden it's ME who is the nurse and it's ME that the residents are going to be talking to and it's ME who is charged with the responsibility of knowing which orders to question and which to carry out...please, please stroke my ego. Let me know I'm doing well. Let me know that I'm on the right path and while I don't want you to be mean to me...let me know where I need to focus my brain at on my next shift so I can do an even better job.

Part of the reason I took this particular job on this particular unit above the others offered to me is the manager. Before I interviewed the nurse recruiter told me over and over again how particular this manager was and how she would know within 5 minutes how I would do on the unit and was very opinionated and would tell me straight up that I wasn't right for the job if I wasn't and are you SURE that you want to interview with ICU??? It was a huge boost of confidence to be offered the job on the spot in the interview and afterwards, during my orientation, it also stroked my ego a bit to see how impressed people were that I had been hired directly out of school, with no ICU experience and without ever having worked at my hospital before. I think part of that is because my manager knows what she's looking for and has worked ICU long enough to know what kind of person can do the job and I was lucky that she sees that in me...That gives me at least a little confidence that I can do the job. Plus the fact that I don't think my manager will LET me fail...that helps a lot. I don't think she would put the time and money into training me if she thought I'd fall on my face.

However...my managers confidence in me and my OWN confidence are two totally different things. I do NOT like going into situations where I'm not sure I'll do well. I like to do things I excel at. Take pool for instance...I know that the basis of pool is basic geometry. I was good at geometry on paper. But I can't put the theory to practice on a pool table...so...I don't play pool. This is the same with jager bombs...I can't handle them, so I don't do them. 9 days out of 10, I was a fabulous student nurse. I was on top of my game and ready to go. But I"m not a student any more!!! So much more is expected of me and I do NOT want to flounder.

So, in my true fashion, I've bought books and pens. When I get nervous or upset...or bored...I buy things. For this...books and pens.

Eek! Lucky for me I have three more days to gather my confidence!!

NCLEX

Alright...I take my NCLEX September 29th.

It's a Monday at 8am. Ick.

BUT. I WILL pass the first time because I have given myself ample time to learn what I need to learn in order to be successful.

Shoot...I only need to get 31/60 questions right! Scary. Truly.

Update: For what it's worth...I moved my NCLEX date up to September 7th and took it in Austin. I got 78 questions and passed...I'm an RN!!!!

How much am I worth???

So happy as I am to have benefits, the entire enrolling process is kind of shooting over my head. Picking the health/dental/vision plan is easy enough. It's all the life/supplemental life/short/long-term/flexible spending accound crap that gets me all riled up. Plus the medical plan itself reads a bit contradictory. One place says that say, radiation therapy, isn't covered. But in other places in the policy book radiation therapy is listed as something covered for X,Y or Z. The decision to get short/long term disability is easy enough...If I have a house and I get hurt, right now I'm' not married so it's just me paying for the bills...I need the insurance $$. The question of how much is what is killing me. I just have no idea.

But...plus side is that I get to start my job on Monday because I (yahoo!) got my GN license on Wednesday. woot! Which means I get bennies on Sept. 1st and a paycheck on the 12th!!!!!

Tomorrow I get to go back up to the hospital and have my TB test read and have some titers drawn. What fun! THEN I get to go shop for scrubs!!!!

Trees, trees everywhere!

I am once again a resident of Fort Worth! I got in today after a VERY rainy drive and a very rainy weekend packing.

Contract signing tomorrow!!!!

Bad girl!

So I'm a bad blogger. It's been over a month, and it's been an eventful month, I probably should have stopped by and said hello even though no one reads this.

Events: First off, I graduated from nursing school. That's kind of a big deal. I'm a BSN, pinned and everything. Woot.

Then I spend a week in Lubbock, TX for a Hurst NCLEX review to help me pass my boards the first time. Double Woot. I don't have a picture of me in Lubbock, but I did get a VERY cute shirt!

Since then...I'm packing. Or at least attempting to. I'm going to be very sad tomorrow when I realize how much I haven't done at all and have to start really packing asap, along with selling my freakin' couch and getting a bunch of my crap off to the American Council for the Blind (they come and GET your stuff...woot!) and then making sure I have all the stuff I need for the hospital and blah blah blah blah blah. Plus trying to say goodbye to my friends here. And then leave at some point on Tuesday.

Oh! So my hospital called me last night to see if I could come in and work because they were short staffed...the new hospital that I'm moving for. I was like, um, I don't even have my GN license yet. The girl that called laughed, but I was glad that I was on the call list...that tells me that they're expecting me, which is a good thing because it's been over a month since I got this job.