Wednesday, December 21, 2011

+4 Epic Crowns of Epicness

Today started with two hours of power tools grinding and drilling on my teeth, and the discovery that dental anesthetics don't work right for me.

Marcaine (bupivacaine) is supposed to be the longest-acting of the local anesthetics a dentist can use. Normally, the standard dose of 9mg is enough to keep a site numb for upwards of eight hours. I got a total of 72mg of the stuff injected into my face, and wasn't allowed to have any more, because that would put me over the maximum daily safe dose. I needed that much because for me, the dentists were surprised to learn, the pain-killing effect stops very suddenly after about 30 minutes. That made for some pretty uncomfortable moments, when I toggled from "doing fine" to "my nerve endings are seared by the white-hot flame of the sun itself," without any stops in between.

In addition to the drill-grinding with its intermittent bunches of ouch, and all the sharp needly drug injections, my visit also involved: two dentists, three assistants, a sculptor, several molds, three kinds of epoxy, two kinds of UV-setting enamel, and some funky little blobs of thermoplastic. It's a really fascinating process if you pay attention. At some point I'm sure it will all be accomplished with 3d scanners and computer manufacture, but I suppose the technology just hasn't reached that point yet.

After all that I've got some temporary crowns installed, which are made of plastic epoxy. They feel nothing like my natural teeth and I'm not allowed to bite or chew anything with them. The permanent porcelain crowns will be ready in a couple of weeks, though, and once I've got those in my teeth will be stronger than ever.

Saturday, December 3, 2011

Levels of care


The hospital is packed with very sick people this week. The ICU is so full it's overflowing, and their overflow comes to my stepdown unit. So we had to put some stepdown patients upstairs on the telemetry floor, and telemetry patients out in general med/surg. This situation doesn't mean the patients get any less care; we're just providing that care in a different section of the hospital.

I tried describing this to a friend who's not a nurse, and she asked what the heck I was talking about. So this is probably a good excuse to explain what these different levels of care mean in my hospital.

Med/Surg (medical/surgical, aka "the floor") is the bread and butter of hospital nursing. They care for all the adult patients who are sick enough to be in the hospital, but are quite stable and don't have critical needs. Patients get a vital signs measurement and a complete, head-to-toe nursing assessment every 8 hours. A floor nurse in my hospital can have up to 6 patients at a time.

Telemetry is like floor nursing but for patients who need special attention to their heart and lung function. Patients are hooked up to continuous ECG monitors that read cardiac activity, and sensors that read blood oxygenation level. Any sudden changes in the readings will sound an audible alarm. The patient/nurse ratio here may be as high as to 5:1.

Critical Care Stepdown is where I work. We get patients who are still stable but too sick for the floor, either because their condition is borderline and requires very close watching, or because they have multiple complicated care needs. We are also the first stop for patients leaving the ICU after their condition has stabilized. Assessments are every 4 hours, instead of 8. Each of us may have up to three patients at a time.

The Intensive Care Unit is dedicated to care of the most critically ill and unstable patients. These are the people who, without care, are in imminent danger of morbidity and mortality. Many are intubated and on mechanical ventilation, or have other invasive devices for life support and monitoring. A specialist physician, called an intensivist, is on duty there at all times. Vital signs and assessments are recorded at least every 2 hours (but sometimes as often as every 10 minutes). Each nurse has no more than two patients to care for, and sometimes must spend her entire shift with just one.

Though the different levels don't all have the same equipment or experience, most everyone is cross-trained to handle one level higher if necessary. That lets us deal with situations like last night, when the ICU was already full, when two more patients showed up in the the ED with life-threatening accidental injuries. Those patients needed ICU beds proper, so to make room, the unit sent their two least acute cases over to me.

Even when physically moved to rooms in stepdown, both my patients remained at the ICU level of care. Relatively low-acuity by that standard still means they were still quite sick. One was intubated and on mechanical ventilation, which we were carefully weaning in order to retrain his own respiratory function. The other was a lady on drips of multiple medications to prop up her blood pressure and heart rhythm, requiring lots of adjustment to keep her vital signs within defined limits.

To make room on my unit for them, two stepdown patients got sent up to the telemetry floor. Nurses up there have all the monitoring equpiment required for these patients, and know what to watch for. A few telemetry patients got sent over to med/surg, on monitors borrowed from elsewhere in the building. And if med/surg were full, any new inpatients from the ED would have had to spend the night in the ER exam room on a stretcher. (Fortunately, we haven't had to do that to anybody this week.)

What still surprises me is that the workloads pretty much even out. A med/surg nurse with 2 assessments per shift times 6 patients, and an ICU nurse has 6 assessments per shift times 2 patients. The ICU nurse has more complicated tasks, but never has to answer a call light. Either way it's a busy twelve hours.

Friday, November 18, 2011

Every spoon has "poo" in the middle

As sometimes happens in nursing, I had an inordinately poo-filled night. And I wasn't the only one. It seemed like all the patients on the unit planned ahead and saved up their best contributions for last night.

If I wasn't cleaning poo, or testing poo, or documenting poo, or helping move a patient so they could be cleaned of poo, I was listening to the other nurses talk about their tips and tricks for dealing with poo.

At one point, while I was scooping a sample of poo into a specimen container with a plastic spoon, my imagination went a little overboard. And my brain said, "I'm never eating chocolate ice cream again."

Well, screw you, brain! You're not the boss of me, and I won't take that kind of mandate from a two pound lump of self-justifying grey matter. I'm having a chocolate fudge brownie sundae for breakfast, and there's nothing you can do about it.

Tuesday, November 1, 2011

Critical hit

I have my permanent placement! I am now a staff nurse in the critical care stepdown unit. I've had a few shifts there already, and so far, it's a blast.

On this unit I have only two or three patients at a time, instead of the six on the pulmonary floor, but I'm still exactly as busy. It's just a different kind of busy. The patients are more acutely ill here, so they need closer monitoring, and their care usually has more complex technical requirements.

For instance. One of my patients today had an arterial line hooked up to a transducer for constant monitoring of her blood pressure. She needed that because she had been admitted for hypertensive crisis-- a blood pressure of 230/118 (which can be described as scary high). We were giving her a constant infusion of nitroglycerin to lower that pressure, but dropping it too quickly could interrupt blood flow to the brain, which would be a bad thing. So every N minutes I had to check the trend line of her BP measurements, and titrate the infusion rate slightly up or down to keep her pressure in the target range ordered by her physician. Similarly I had to titrate another drip based on heart rate to keep her cardiac output up, and a third based on blood coagulation tests to prevent stroke. That's not to mention diuretics to remove excess fluid, an hourly tally of urine output, electrolyte runs to counter a side effect of the diuretic, and the obligatory O2 cannula and monitoring of her oxygen saturation. Et so forth and cetera.

And my patient in the next room had his own set of completely different issues.

Overall it was a very busy day, but I think it's a kind of busy that suits me well. I'm picking up the technical skills really quickly. Once I figure out exactly how the policies and schedules differ, and modify the timing habits I developed on med/surg, I think I'll have a really good handle on the job.

Oh, and about that skills assessment I had to do a little while back? The one all new grads are expected to fail? I aced that sucker. Go me.

Sunday, October 23, 2011

Getting it together

Orientation is almost over. I'm doing really well. I still feel like time tries to get away from me, but I definitely have a better handle on it than when I started.

High points of what I have come to grok over the last few weeks:

Don't compare newbies to veterans. Nobody expects me to have the same speed or skill as my preceptor. She's been an RN for seventeen years. She has a ton of practice, she has the routine down, and she almost never needs to stop and look anything up. Of course she's going to be faster than I am. I still get my work done during my shift; I just expend more effort and have less time to sit down.

Teamwork is key. The patient care tech or CNA can handle a lot of the most time-consuming tasks-- from routine vital signs and blood sugar checks, to turning patients and giving bed baths. I do all of those as well, but I'm also responsible for tasks that only a licensed nurse can do. I need to remember to delegate early and often, to keep the tech as busy as I am.

Not everything happens on time. Morning meds are scheduled for 0900 and are considered on time within an hour either way. Some days there's just too much to do between 8 and 10, so not all the meds get passed within the window. This is not the end of the world. Make sure time-sensitive tasks (like IV antibiotics) happen as scheduled, and catch up on the rest as soon as possible.

Sometimes there is only one right way. Blood is a good example. There's a very specific procedure for transfusing blood. It involves many checks and verifications, with dual signoffs. It has explicit time constraints as well, but there are vital safety concerns and no step may be skipped or half-assed.

Sometimes there is no right way. Every nurse has their own intuitive system for managing their workload and getting the work done. No two do things quite the same way, but if they all do their jobs, none of them is wrong. This isn't really something teachable or memorizable. It has to be developed through experience.

Saturday, October 1, 2011

Swim. Don't Sink.

This week, after a little more classroom training, it was time for actual patient care! Two twelve hour shifts on the floor. I've heard this fellowship starts out easy, and only slowly ramps up to a full patient load, so I wasn't worried.

On day one, my preceptor had six patients and assigned one to me. When not busy with my patient, I followed the preceptor around to observe and assist.

Day two: "Ninj, here are your five patients. The preceptor will be here in case you need help. Go."

That's slightly less gradual than I was expecting.

I think I did really well. I managed the routine stuff on three patients by myself without needing much prompting, and the other two with assistance. When non-routine things happened I either handled them myself, or went to get the right help. I delegated tasks when necessary. Since I'm not yet very fast and I don't have my routines down, I had to delegate more than a few times.

I need to work on my time management skills.

In fact, that's probably why the fellowship has switched away from the gradual ramp-up. Time management is the hardest part of this job, and caring for five or six patients is at best an exercise in controlled chaos. A minimum load just wouldn't pressure me to learn all the necessary skills. An easy first day was helpful, so I could learn the unit layout and stuff like that, but after I got oriented I'm kind of glad to start the real work right away.

I may have been kicked into the deep end, but so far I'm treading water just fine.

Sunday, September 25, 2011

Expecting To Fail

First week at the fellowship was orientation, skills checkoff, EHR training, and probably failing a test.

One whole day was devoted to a "Performance Based Development System" assessment. It's a computer based test that's supposed to see how good I am at thinking like a nurse. It gave various patient situations, either by text, image, or video. In every case I'm supposed to figure out what is wrong, and write down every single thing I'll do in response. In the right order. After only one viewing. In a very tight time limit.

We are not expected to pass.

Since we're all new grads, no one expects us to have the full nursing skill set yet. The fellowship leaders say it takes about one full year of real-life hospital nursing to get there. The point of this assessment is to note what skills we have already, and where we most need practice and assistance.

Me, I'm great at recognizing situations and calling up facts. If you show me a post-op ortho patient with sudden chest pain and shortness of breath with hemoptysis, I'll correctly say "suspected pulmonary embolism" and tell you that I need to immediately put her on O2 (to start with). But where I'm weak is on policy and prioritization. I know PE is an urgent situation, but how urgent exactly? Is this a situation where I go page the physician, or do I stay in the room and call for the rapid response team? It depends largely on the patient's status and vital signs-- which the video helpfully avoids giving me-- so there is no rote, textbook answer for me to call up.

For this exam I tried to err on the side of caution, so I probably wrote to call the RRT when I should have been paging the doctor, and paged the doc when I could have handled the situation with independent nursing actions. We'll see what they tell me about that. The tests have to be read and graded by live humans, so I won't find out how I did until next week.

Monday, September 19, 2011

Suddenly, Lungs!

Started my new job at the hospital today. This week is all orientation and some redundant computer training, but clinical work should start next week.

It turns out I didn't get the ED slot I tried for. My initial placement is instead going to be on pulmonary med/surg.

If I'd had a choice, I would probably have put pulmonary at the very bottom of my preferences list, just because I know there will be lots of patients with tracheostomies. Out of everything I did in clinicals, trach care was the only thing that ever grossed me out. (It's something about the suctioning.)

I expect I will shift around and look at fellowship openings on other floors. But who knows? I might find out I like the lung unit. In any case I'm sure I'll learn a lot, because the patients are high acuity and have lots of varied problems. If I stay there long I'll be awesome at airway management.

Thursday, September 15, 2011

Irene Day 15: Out

Albany HQ is closing. The need for ARC services in this region has reached a level the local chapters can handle. Many of the national volunteers from here are relocating to Binghamton, where the urgent and immediate needs are still great.

When I got here the control center was always jammed with people, and so loud you had to walk outside to take a phone call. Right now I count six people in the room. The quiet is almost spooky. By tomorrow, they will have moved out the computers and rearranged the tables, and the war room will have transformed back into the chapter's CPR classroom.

My day was slow. I had only two followup calls to go out on. We also had a meeting with some local nurses and ARC personnel who will be taking over Health Services duties here. I spent the rest of my day inventorying the shelter health kits (which are enormous wheeled duffels with the unfortunate nickname "body bags") and finishing my outprocessing paperwork.

I fly out in the morning.

Tuesday, September 13, 2011

Irene Day 13: Ramping Down

HQ has been getting a lot quieter this week. That's all part of the plan. 

The role of the Red Cross is to help with the most important and emergent needs, immediately after the disaster. As those needs are met, as people and communities move into the long-term recovery phase, ARC services give way to FEMA and local institutions.

People have been getting outprocessed and redeployed pretty steadily. When I got here we had thirteen people on the Health Services team. As of tomorrow I'll be one of three, and the only RN. 

If we keep getting enough referrals from Client Services caseworkers to stay busy, I'll be here until Friday. But with nearly all the referrals done, and nearly all the caseworkers redeployed to places like Binghamton or Harrisburg, I may be going home even earlier. 

That would be just fine with me. Two weeks is a long time to be away. 

Sunday, September 11, 2011

Irene Day 11: Wait, eleven? Really?

Days are flying past. I last posted here a week ago and it feels like no time at all.

I can't say that the minutes always go as fast. Sometimes I have to wait for paperwork, or for an assignment, or for a client to show up. But every day has been full enough that I've gone to my bed early and eagerly.

Part of the effort is just all the driving. My regional sub-HQ is covering many counties in northern New York State, to the tune of seven thousand square miles. That's an awful lot of space for a dozen nurses to cover. The damaged towns are mostly in pockets and concentrated areas-- e.g., along certain flooded creeks-- so we can see many clients on any one trip. But still I've put over 1300 miles on my rental car since I got here.

Tired as I am, the accomplishments are completely worth it. Today I helped more people who lost medical supplies and could not afford to replace them. Phone calls to the pharmacy, the doctor, the insurance company, back to the pharmacy. Often a supplier will waive fees for victims of disaster. Sometimes we negotiate a discount. If all else fails we issue monetary assistance. One way or another our clients will get their medications, or oxygen, or dentures, or whatever it is they need.

Perhaps no lives dramatically saved today. But maybe tomorrow, or next week, because people have their nitro or coumadin or insulin. If not saved, then someone's life improved, because he now has glasses and can start fixing his house. So glad I got the chance to come and do this.

It seems like every blog today has posted some kind of 9/11 observance. Me, I don't have much to say about those horrible events. My response instead is this: I'm trying my best to make the world a better place.

Monday, September 5, 2011

Irene Day 5: What Holiday?

Today, reassigned to go out with a pair of social workers. That's the first time I've done any nursing job without another RN anywhere on site. Didn't even realize it until just now.

Spent most of the day in an extremely hard hit town. It's at the bottom of two mountains and the water came through in a flash flood, like an inland tsunami. Some buildings were flattened entirely, and many more were shoved off their foundations and will have to be demolished. The ones still standing have had all their contents completely destroyed; the high water mark for most of the town is well over ten feet. Even the rafters were underwater.

You've all seen photos of the aftermath of Katrina. This is like that.

Our plan there was to canvass the town and go door to door, finding individual people needing help. But before I could even cross the first street I got flagged down by a man with a nasty gash on his arm who needed help with it. I cleaned and dressed the wound, and before I was done a younger guy with a bad bruise was asking me to have a look at it.

The rest of the team fanned out across the town as planned but I set up shop outside at the big church on Main street. The shiny Red Cross vest makes me visible from a mile away, and I hung my stethoscope around my neck to advertise my job. Together that was as good as setting out a neon sign and using a bullhorn.

I spent the whole afternoon on first aid. People doing cleanup work get lots of scrapes and cuts, and those are always full of the mud that covers everything in the town. Then there are the bruises and sprains, not to mention the assorted skin rashes from spending too long wading in contaminated floodwaters. Nothing was too serious, but everyone really appreciated my being there for them.

I even got to be logistical assistance in a bigger way. Long story, that part, but I happened to learn that the supplies of some things were getting critically low. (Gloves, cleanup kits, proper filter masks, others.) That's technically not my department, but I decided I could make it my department, because lack of masks is a health concern. I collected lists and contact info, and called HQ to try and pressure the folks in Bulk Distribution. Long story short: the people here are going to get all of what they need, by tomorrow.

All in all I'm totally happy with what we accomplished today. Compared to the vast total need out here it is just a drop in the bucket, and that's intimidating. But in terms of the work doable by one human in a single day, I think every one of us should be proud.

Sunday, September 4, 2011

Irene Day 4: Nursing In The Field

Yesterday I got my first work assignment. I was teamed up with another RN to do what the Red Cross calls community outreach. That just means instead of stationing at an established shelter or other fixed location, we go out and actively search for people who need our services. When anyone has a health need caused by the disaster-- whether a cut finger or a lost walker or contaminated medications, or anything-- our job is to help fix it.

We spent a big chunk of yesterday with large groups. For instance we talked to the command staff for several local fire departments. They're doing great things, feeding dozens or hundreds of people per day and providing supplies and tools for people trying to clean up. They know their residents and neighbors and they were able to direct us where we might be needed. We made a few nursing contacts, and also put the chiefs in touch our Mass Care and Bulk Distribution people.

One of the FD commanders pointed us down a route that had been blocked by a huge landslide until that morning. A single lane is now mostly open. The National Guard was posted at the entrance, turning most people away, but we showed our Red Cross ID and they let us right through.

The town on the other side was in great shape considering they'd been mostly cut off for a week. Their local FD and EMS crews had been keeping them supplied by making runs across the flooded creeks with boats and ATVs. And when we were led to the command post we found it included an impressive outdoor kitchen, completely staffed with volunteers, that was feeding practically all the people in town. Not many residents there needed assistance at all.

But they told us about yet another, smaller area that is still cut off. Every single bridge in has collapsed, except for one that was severely damaged. No vehicle traffic can pass. The only ways in are by small boat or on foot.

800 people are stuck on the wrong side of that bridge. Anyone who is elderly or infirm cannot leave town to see a doctor, or even refill a prescription. They have already needed one helicopter evacuation. That sounded to us like an area with some health needs. So my partner and I packed portable kits and walked ourselves in.

We arranged to meet a knowledgeable resident on the other side of the bridge, and spent the day going door to door.

Friday, September 2, 2011

Irene Day 2: Short Update

It's been a busy couple of days. However it's been all travel and logistics, which don't make for riveting stories.

Getting everyone on site has been a headache for the transport people. Air schedules are still so disrupted that a few nurse teams had to fly into DC or Baltimore, and come the rest of the way by car. I was blessed by the travel gods and scored a flight to LGA, and I beat rush hour traffic out of the city on my way to HQ in White Plains.

After that plus in-processing and orientation, it was already too late in the day for me to get a shelter assigment. I finished the afternoon helping to find and assemble supplies. I made runs to the local ARC chapter house and the one in Greenwich to pick up nursing bags from very friendly, unbelievably busy people.

Spent last night in an employee bunkhouse. This one happens to be in cabins donated by a wilderness camp in Carmel. It's up in the woods of the Catskills, a really gorgeous area on a small lake, far enough into the country that I could see the Milky Way in the night sky. The scenery made up for having to share a cabin with a dozen other people. I'm bummed that it was too dark for my phone camera to get any pictures.

This morning, I was one of several nurses tasked with work in the Albany area. So we made the necessary requisitions, piled into vehicles and travelled up here. Now we've got actual assignments, and that's really exciting. Unless something changes overnight, tomorrow I'll go on duty at a shelter and do real work as a disaster nurse. (Actually a lot will definitely change overnight. The situation is fluid. But it's more than likely that this one shelter will still need me.)

Staying the night nearer Albany. Not as pretty, this place, but there are fewer roommates. Somebody in here probably still snores though.

Wednesday, August 31, 2011

Deploy

I'm on my way to the East Coast to do disaster relief. Irene left a hell of a mess and the American Red Cross is on the ground to help.

I've been a Red Cross volunteer for a couple of years now. Up 'til now I have been doing local response-- I've worked dozens of house fires and a few local floods-- but this is my first assignment to deploy out of town as an RN.

Being called up for a national disaster is an interesting experience. After getting the phone call, I must start travelling within 24 hours. That woke me up pretty fast, because I knew I had a lot of stuff to do at home before running out to a two-week trip. Yet, for the deployment itself, I can't prepare all that much, because I don't know where I'll be assigned or which kind of disaster nursing I'll be doing.

I have a flight to the in-state airport, I have the address of HQ, and I have a way to get from one to the other. I'll figure out the rest of the details once I hit the ground.

Friday, August 26, 2011

My band

I'm starting a band with some other new RNs. We call ourselves "Tracheal Shift," and we do Inuit throat singing over heavily downtuned electric guitar.

Sunday, August 21, 2011

Everyday nursing

So I've officially accepted the hospital job. It doesn't start until mid-September, which means my next few weeks will look exactly like the previous few weeks. Yet I'll be a lot happier. Now that I have a start date, this is not unemployment; it's vacation!

But one of the coolest things about being a nurse is how my skills are useful even without a job. I'm not even talking about volunteer work. I mean just getting to answer healthcare questions for my friends and family. I love this.

Earlier this summer, my brother and his wife called with some pregnancy questions. A week ago a friend dropped something heavy on his foot, and wanted to know about the infection risk from his prescriptions. Last night, I helped a friend and his daughter figure out which OTC cold meds could be safely combined, and which would interact or overlap.

One day questions like this may become a chore, but right now I geek out at every chance to show off my RN superpowers. It's one of the reasons I'm sure I have chosen the right career. Back when I started as a techie, fixing mom's computer just never had the same zing to it.

Thursday, August 18, 2011

Two for two!

I've got verbal offers from both places I interviewed. Woohoo x2!

Choosing between them is going to be interesting. The long-term ICU has an intensive training program for dealing with high-acuity and stepdown, but is very specialized to that kind of nursing. The Large Hospital System fellowship has a much broader training scope and a much wider variety of positions.

There's a salary difference, too, but the one that pays more will require a contract to work there for N months. I'm not certain that the extra cash is worth giving up that much freedom. (If money were my top priority I would have stayed in IT.)

What the hell, I'm going to not even think about that stuff now. Time enough when the paperwork arrives. For now I'm just happy that I've got employment lined up and will not be spending the rest of my life on the couch.

Tuesday, August 9, 2011

Two shots

Yesterday was the interview for the fellowship I talked about in my previous post. That was a short meeting, with some "tell me a story about" bits (easy) and some of those annoyingly squishy behavioral questions (less easy). I think I did well enough and I feel good about my chances.

It helps that I've passed NCLEX already. And it helps that there are between 60 and 80 openings in this fellowship. Plus, I killed time talking with some of the competition from other schools, and I like to think I compare favorably against them (if I do say so myself).

A few of my classmates were also there to interview at the same time. They're all quite brilliant and very nearly as awesome as I am, so they should get the next spots after me. :)

Then, today, I interviewed at a long-term acute care facility. I gave them my resume at a random job fair a short time ago and was shocked to get called in so quickly. This one felt like it went very well, to the point that they spent more time telling me about the job than asking questions. They even gave me a tour of the facility and a description of how scheduling works. This place only has four openings, but I get the distinct impression that the interviewer wants to offer me one.

The LTC says they will send out offers next week. Given the choice I would prefer the hospital, but they won't be deciding for 2-4 weeks. If I do get an offer from the LTC right away, I wonder how long I could stall before answering?

Wednesday, July 27, 2011

Baby Steps and Fellowships

I had a phone interview with a recruiter for Large Hospital System. It went well enough because I've been invited to interview in person! Progress!

LHS does their fellowships differently than every other hospital I've talked to. They don't hire a brand-new nurse for any particular position. Instead they bring on a few dozen at a time and train them all at once. After the classroom work, they rotate everybody through clinical training in multiple specialties at multiple different hospitals. It sounds almost like a bigger, more focused extension of nursing school clinicals, except that this time I'd be getting paid to learn.

Successfully completing the training guarantees an offer for a full-time RN position. But though they take your aptitudes and preferences into account, you don't know ahead of time which position will be offered. It's entirely possible that I could be offered the ED or ICU position I really want, but there's also a chance that I'd wind up with an offer for psych, or OR, or something lower on my priority list

That's only a minor downside, and it's outweighed by the last upside: LHS does not ask for employment contracts! Nearly every hospital system around here requires a two-year work committment before you can start the fellowship. At this system, after completing it you're still only given a job offer, which you're free to decline. Even though I've got no plans to move or quit in the immediate future, I feel a lot more comfortable having the option just in case something weird comes up.

This sounds like a great opportunity. It's just going to take a little while to come to fruition. The interview is still a few weeks away, and the fellowship itself does not begin until late September sometime. I have already sent in all my applications and essays and recommendations, and confirmed that they were received, so now I've nothing to do on this front but wait.

(...and keep applying for more jobs elsewhere. Just in case.)

Thursday, July 14, 2011

My Band

I'm going to start an RN band. We'll call ourselves "Metacarpal Stress Fracture" and play bluegrass speedmetal.

Monday, July 11, 2011

The Search

When I first told people I was making this career change, I got lots of different reactions. One remark almost everyone made is that, in nursing, at least I would always be easy to find a job. I thought the same thing. As it turns out, when you're a new grad here in Large Midwestern City, it's a lot harder than you think.

The problem isn't that there are no jobs. It's just that the market is flooded with new graduates. At my university alone there were near 100 of us in the ABSN program, and about the same number again in the traditional 4-year program. Extrapolate that out for all the other nursing schools in the area, and the number you wind up with is a job applicant's nightmare.

There are quite a few hospitals in town, but each one can only take on so many new grads at a time. See, nursing school does not prepare us to be fully independent practitioners of nursing. It prepares us just enough that we are ready to learn the rest. An RN's first hospital job will generally provide about 2-4 months of additional training and supervision, which makes hiring a new grad very expensive. With only so much money to go around in this economy, entry-level RN positions are getting a bit scarce.

By this point I have already tried the easy path and called on my friends, acquaintances, contacts, instructors, preceptors, and clinical sites. Nepotism has failed me. I'm down to sending in blind applications for open job postings.

Thus far it seems like my applications are not clearing the first hurdle, because I just haven't been getting any calls back. I'm sure that once I interview I can impress a nurse manager and land a position, but my resume must not be hitting the right health care buzzwords for HR. All my fancy leadership and collaboration experience is listed under IT jobs which they probably aren't bothering to read.

This week I'm going to step it up a notch. Instead of doing as the ads say and waiting for a response, I'm going make lots of phone calls and actively pester the HR folks. It may not be entirely polite, but it has worked for several of my (now freshly employed) classmates. Besides, it can't generate any fewer interviews than my current strategy.

Friday, July 1, 2011

The Great Renaming

The votes are in. This blog is being renamed to: Registered Nerd.

The old name was "Trust Me, I'm Almost A Nurse," which no longer applies to the real, actual, fully-licensed nurse who is me.

I'm keeping the silly scrubninja URL (and username) because it's distinctive and short, and because silly is good.

Friday, June 10, 2011

The Next Urgent Task

Now that I am a licensed, registered practitioner of the art and science of nursing, there's a major issue that I need to address as soon as possible.

I'm not talking about finding a job. No, sir! I'm on the Internet and am not concerned with such mundane realities. This is way bigger than that.

I need to find a new name for this blog.

"Almost A Nurse" doesn't describe me anymore. Blogger won't allow strike tags up in that section, which means "Almost A Nurse" won't fly. So I've got to think up a new title that is clever, memorable, and (preferably) accurate.

Seeing as I'm still unemployed, I have plenty of free time to work on this myself. But I'm also open to suggestions.

Wednesday, June 8, 2011

Passed!

That's Mister random stranger on the Internet, RN, BSN, if you please.

Now, if you'll excuse me, I'm gonna go dance like a muppet.

Monday, June 6, 2011

Cue the ominous Latin chanting

I am off to take NCLEX. We need some epic boss-fight background music up in here.

Wednesday, June 1, 2011

Hyperventilation and tachycardia

I have just received my Authorization To Test (ATT). This is important. It means the state board of nursing has verified my graduation, and I am now allowed to sit the licensing exam.

NCLEX is a big deal. It's what we GNs have really been studying for over the past year. It is the beast that stalks our nightmares. Professors invoke its unnatural power to increase student attention, by reciting the mystic phrase: "You will need to know this for NCLEX."

It is of course a computer adaptive exam. It stops automatically as soon as you reach the passing mark, so if you're lucky and good, you can be done as early as question 75. Most people are not that lucky. The maximum limits are 265 questions and six hours. Plan on skipping lunch.

While typing this post I have been on hold with the testing center. As of this minute, I am scheduled to take the exam in early afternoon on Monday, June 6. I go now to bury myself in notes and flashcards until that time.

Thursday, May 19, 2011

My Band

I'm starting a graduate nurse band. We call ourselves Purposeful Movements and we do hip hop covers of classical orchestral symphonies.

To commemorate our graduation today: an acid breakbeat version of Beethoven's "Ode To Joy."

Sunday, May 15, 2011

Milestone

I created this blog over a year ago, when I was about to start nursing school.

I didn't have as much time to write in it as I expected. School has been kicking my ass nonstop for the past twelve months-- and I mean that in the best possible way. This was the longest, shortest, busiest year of my life.

A year ago, I wouldn't have recognized a good nursing assessment if it ran me over. I couldn't have told you the difference between dilaudid, dilantin, and diazepam. The main thing I knew about IVs and injections was that the sharp end goes in first. But at this point, if you believe my instructors and preceptors, I'm getting pretty near competent.

I put in more hours of hard work for this, than I have at anything else in my life. I haven't been doing much of anything outside school. I've got notes and textbooks stacked on every flat surface of my house, and huge piles of flashcards. And finally, after all that, it's done.

I officially graduate in six days.

Go me.

Tuesday, April 19, 2011

My band

I'm starting a new band. Or rather, I'm going to be the manager. The musicians are all female Red Cross disaster workers, and are calling themselves "Tornado Sirens."

Saturday, April 9, 2011

ED means "Emergency Department"

On my first shift in clinical, my triage gave to me:

Twelve hours learning
Eleven nurses nursing
Ten techs a-testing
Nine liters saline
Eight minor bleeding
Seven doctors docting
Six psych admissions
Five IV starts!
Four broken bones
Three chest pains
Two MVCs
On my first night in the ED

Sunday, April 3, 2011

What's The Difference?

A friend just asked me about the difference between the nurse acronyms-- RN vs. LPN vs. BSN vs. ADN. The simple explanation is that RN and LPN are license levels, while BSN and ADN are degrees than an RN may have.

A Licensed Practical Nurse (LPN) typically has a year of career training before licensure. To generalize, LPN education focuses on caring for patients in stable condition with predictable outcomes. They can do the large majority of hands-on physical tasks (meds, IVs, catheters, wound care, etc) but they are not trained in the underlying theory. What they can't do are tasks that require assessment and independent action, like administering blood products. An LPN works under the direction of doctors and RNs.

A Registered Nurse (RN) gets a college degree before licensure. In addition to the physical tasks, they have more leadership and decision-making responsibilities. An RN does assessments, makes nursing diagnoses, provides education and counseling, and delegates care tasks to LPNs and unlicensed personnel. RNs are considered professionals in their own right; though they work with doctors in providing medical care, they act independently in providing nursing care.

The RN may have an Associate's Degree in Nursing (ADN) or Bachelor's Degree in Nursing (BSN). There's no difference in what they can do in practice, but the BSN-prepared nurse has a stronger grounding in nursing theory, pathophysiology, and assorted other science.

Of course these are just generalizations. An LPN who's been around for years will know a lot more than a brand new BSN-prepared RN, even though the LPN didn't have as many credits in school. And all nurses do a lot more than the few examples I've listed.

Sunday, March 27, 2011

Two Months And Counting

Holy crap you guys, I am nearly done with school.

The final semester is most of the way done and things are starting to wrap up. I have sat through my last classroom lecture, tomorrow morning I have the final for that course, and then it's just clinicals and assignments.

Let me rephrase that in a more appropriately melodramatic fashion. At this moment I have all the book knowledge I need to become a registered nurse. That's just such an intimidating concept, I think my brain may have scared itself.

The major visible thing that's left is the comprehensive clinical, also called the "capstone." That is six weeks in one department, working like my previous clinicals only a lot more so. By the time I'm done I should be able to take a handful of patients mostly on my own, with my preceptor looking over my shoulder-- where last summer it was the other way around.

Aside from that I have to write two papers, analyze a psych process recording, lead a discussion group, finish my community service project, and create an academic seminar presentation. I'll be busy but it's not a much heavier workload than I've been doing already.

Then, in less than two months from today, graduation! The end is in sight!

...and then NCLEX. The licensing exam. Devourer of nursing students. The beast that stalks our nightmares.

But I'll burn that bridge when I get to it.

Saturday, January 29, 2011

My Band

I'm going to start a nursing student band, called "The Extraarticular Manifestation." We wear black bone armor and scream unintelligble lyrics about Mordor.