ADN, BSN, MSN!

So during this past year, I’ve been working on my Bachelor’s degree (BSN) in nursing at Arkansas Tech University.  It’s wasn’t hard, but just a lot of busy work!  And if you know me, I tend to procrastinate! haha, which leads me to many last minute papers!  So, as of December 17th, 2011 I am now a RN BSN! Woot!

Sometime in November, I got a letter from University of Arkansas for Medical Sciences (UAMS), granting admission to their Masters program starting in January 2012!  Woot!  I’m super excited!  I will be in the Acute Care Nurse practioner and Nurse Educator programs, with a graduation date of May 2015.  Yes, three more years of school.  ACK!  I went to the campus in November to meet my advisor, who is wonderful, and her credentials are outstanding!!!  I was like a silly school girl on campus! I hope to go back in the next few weeks and get a official “UAMS Nursing” shirt/jacket.

So, for now, I continue to work in the ICU and do house supervisor.  In January I also start to teach clinicals at National Park Community College (NPCC), where I got my ADN (Associate degree in nursing).  Remember that day?  If not ~~~~>>>>HERE and HERE and HERE!!!!!  Yes, so I will be doing the 4th semester clinicals (last semester!), which I’m very nervous about, but very excited!

 

Plan of Action

Back in the day, when I managed restaurants, we always had to have a plan of action.  Depending on what area you were a manager of depended on your plan.  A plan to lower food costs, labor costs, etc, etc, etc.

I have started my plan of action.  I filled out my financial aid information (FAFSA).  Yup, sure did!  I’ve been in contact with UCA and UAMS, and getting advice on whether I should get my BSN or go right into my MSN.  I’m excited, but afraid of the cost!  UCA tuition is $206 for undergraduate and $245.50 for graduate – Per credit hour!  ACK!  UAMS is $198 and $281, respectively.  WOW.  Just WOW.

I’m hoping to start this fall, if not January at the latest.    Wish me luck!  (OMG, what the heck am I thinking, going back to school!!!!!!!)

 

Being a Nurse

So I’ve been on my own for a month now.  A few things I’ve come to realize:

1.  I love my job.

2.  Yes there is a nursing shortage.

3.  I have great organizational skills and time management skills.

4.  I need to say no.

Let me explain.

1.  I really do love my job.  Being able to teach people, talk to them, change a dressing or two, it’s great.  My paychecks are wonderful!  Better than I had planned.  I love only working 3 days a week.  I really do love it.

2.  Let’s skip this, I’ll hit this one on number 4.

3.  I’ve always been this way.  One of my first jobs was a waitress at Shari’s, which is like an IHOP.   We would have 7-12 table sections, do our own drinks, taking orders, salads, service, etc, and even bussing/cleaning our own table, and many times seating our own guests.  I was really good at it.  I’ve worked as a server and a bartender for many years and am really good at it!  As a manager, I’d be able to to the money count, inventory count, or whatever much faster than others, because I was more organized.  Now that has carried over to my Nursing job, which is really helpful when you have 15 patients.  Sigh, number 4.

4.  Most of our hospital is team nursing, meaning 1 RN, 1 LPN, and 1 PCT (CNA) take care of a group of 10 (sometimes 15) patients.  It works ok, if you have a good and helpful team, and if the other team is also helpful.  One floor does primary nursing, which during the day time they have 5 RNs and 1 LPNs (making 5 patients each) and a charge nurse, and at night it’s 4 RNs, 1 LPN, (6 patients each)and a charge.  The charge nurse opens the charts for the LPNs.  Meaning, they do the assessment and documentation for the first of the shift.  Any other thing that needs to be documented can be done by the LPN.  Of course ER and ICU are all their own entities, so I’m including those units here.

In the last month we have lost our travel nurses.  I believe there is one left on the cardiac unit.  The hospital spent so much money on them, they decided not to renew their contracts.  One bad thing about them, is that most of them live within an hour or two drive and still get paid travel nurse wages.  Well, being in a rural area, most of our nurses travel to get to work anyhow.  So many of them have signed up with travel companies, and we have lost nurses.

So one night, I was put on the primary care unit, and made charge nurse.  Ok, fine.  But due to a shortage of nurses, staffing pieced a staff together.  Which meant there were 2 LPNs, 1 experienced RN, and 2 new RNs (one of which graduated with me).  Ok, fine.  So I had to chart on 12 patients, plus deal with any other issues.  Ok, fine.  But I had to do it all by 11 P.M.  when I would be moved to the oncology floor.  Ok, fine.  I managed to chart on 11, helping a newer LPN with some skills she hadn’t done yet, calling the doctor for the new grad, among other things.  At 11, I went upstairs and received 15 new patients.  The nurse leaving had charted on 5 of them.  One room was empty, and two patients were new and needed to be admitted. That left 7 patients to see.  This is where I began to think it’s crazy.  Thankfully, another nurse (the 3pm to 11pm charge) stayed until 2 am admitting the two new patients.  I had another who was really ill, and had to have his bed changed every 30-45 minutes (not to mention he was in isolation), and be given three units of platelets and some chemo.  Thankfully I did not have any blood to give.  I ended up seeing my last patient at 6am, right before shift change.  Crazy!  I also had to draw the morning lab and get two patients ready for surgery.  Thankfully I had a good LPN and PCT, who were experienced and knew how to get a job done.

Good ol’ hindsight says I should’ve said no.  It’s my license to protect.  My job line.  My family’s income.  I am not superwoman, and I need to say no.

Oh, the week before the night above, I worked on the senior behavioral health unit.  I’ve worked there many times and a PCT, but never a RN.  The paper work is COMPLETELY different, including the three times more paper admission packet.  So two weeks out of orientation, I was sent to the pysch unit.  No problemo.  Except that I had three new admits.  UGH.  Now in this unit, there are 14 patients, 1 RN, 1 LPN, and 2 PCTs.  Great.  So the day RN stayed and did one admission, leaving me two.  I managed to get them 90% complete.  Again, thankfully my team was experieced and worked on that unit, so I didn’t have to follow up on them very much.  The day after the charge nurse/oncology floor experience, I was put back on the psych unit (no, not as a patient), again, with 3 admits.

This past week, I worked on the pysch unit (again).  Except, now they opened 4 more beds.  18 patients, TWO RNs, ONE LPN, and 2 PCTs.  IMO, still not enough staff.  These patients have schizoprenic disorders, depression, combative agression, dementia, etc, etc, etc.  So after a rough start, and somewhat quiet middle, around 4 am, the most ambulatory patient on the unit fell and broke her hip.  Of course she was my patient.  Nice.  I had to call doctors, the house supervisor, get her transferred to the med/surg floor.  What a mess.  Now, I’m not saying that wouldn’t happen with more nurses, but I do think that once again, I should have said no.  NO, NO, NO!

I’m learning, I do love it, we’ll see what the next three nights have in store for me!

 

Busy and Stressed Out Mom!

NCLEX.  Boards suck.  The review class that I took said that from now til the time you take the boards (for you non-nurses, this is our licensure board) you need to answer AT LEAST 5,000 questions!  OMG!  Depending on your date, that could be 150-300 questions A DAY!  Oh, and they tell you the longer you wait, the statistics for passing lower.  Great.  There are so many topics, diseases, fields, approaches,  and so on.  I have 4 NCLEX books, each with a disk of 1,000-4,000 questions on the CD, plus the questions in the book.  And there is an on-line one I use, that has another 3,500 questions.  HOLY CRAP!  Choosing how and what to study is so hard!

Anyways, I won’t say when my test is, but it is in the first two weeks of July.  I don’t want the pressure of having to give y’all an pass or fail.  If I fail (WHICH I WON’T), I want to take it in, does that make sense?  But when I PASS, I’ll be yelling, texting, emailing, myspacing, hitting up every blog telling everyone!  HA!

My kids have been pure evil.  Pure evil.  I worked the other night, and came home to Michael sleeping on the couch, where he had fallen asleep while watching a movie (reviews to come later).  I went in our bed.  I woke up about 10 am to yelling and screaming.  Apparently my wonderful children decided that they needed to open their window, kick out the screen, climb out, and go to the shed.  From there they brought multiple things in.  This includes the motor/steering column from their water boats, a box of sewing stuff, a box of paint for model cars, and so on.  Stuff they did NOT need, hence it being in the shed.  Further than that, they decided that the spools of thread needed to be made into spider webs around their room, so I lost about 10 spools of thread.  “Oh, that’s not bad”, you say?  Well how about this:

 

Yes, that’s paint.  All over the carpet, all around the room.  All on the walls.  All on the dresser.  All over them.  Not a happy mother.  However, my MIL (mother in law), who is your typical grandmother, letting them have whatever, saying maybe as opposed to flat out saying NO, told them to go in their room for being naughty boys when she came over that day.  I was very pleased at her for standing up to them. 

Michael is doing well.  Did I mention he dislocated his knee a few weeks ago?  It still bothers him.  He’s had a third interview with a company, so we are waiting on an answer from them!  Cross your fingers!  Meanwhile, he’s working at a jewelry store and had me come look at rings (since mine is gone).  OMG, he had picked out the hugest most beautiful rings!  How sweet of him!

Anyways, I hope y’all find your summer going well, as ours is off to a rough start!

 

Really? That’s what you are going with?

Travel nurses.  What a bitter taste it brings to some RN’s mouth.  They often ask, if they can pay THEM that much, why can’t they pay US that much?  Of course during this nursing shortage, travel nurses can be a life saver to the already worn out, overworked staff.

So after those lovely thoughts, last night was my first experience with a travel nurse.  Our group had 10 patients on a med-surg floor.  Quick run down of clients  (very vague-HIPAA!):  A mix of 1, 2, 3 day post op clients, most with PCAs, one  DNR on a 100% non-rebreather.

One client is suppose to go home, but wants to stay until the morning so he can get the results of a certain test.  One is still in surgery, may or may not come to the floor (vs ICU).   The DNR has O2 sats in the 70s.  After asking me several times if she needed to pass any of my meds (and me declining several times), she still passed meds to one client (couple of POs).  In passing I tell her that one clients IV has gone bad and I’ll fix it later.   In the meantime, the charge nurse was dealing with the one wanting to go home (calling all the doctors, making sure the client could stay), with the DNR client’s family, and with one client who was throwing things (calling their doctor).  The surgery client comes to the floor, the travel RN goes and assesses him.  Next thing I know, she’s is leaving.  Like leaving to go home and not finish her shift, or the remainder of her seven (of eight) weeks.  WOW.  Just WOW.

Her reasoning was that it wasn’t safe practice, she was having to give meds (really now?) and it was too much to deal with.  She had charted on not one client at 10PM, only really dealt with the post op client, and the one to be discharged for a few minutes.  There were two other strong RN’s on the floor (plus the charge), three LPNs (experienced) and the two PCTs.

Really, I just would think that this would be considered abandonment, but since she gave report to the other RNs, I was told it was not considered as such.  Is this what we are to expect from travel nurses?  This is the first time in the 100 year history of the hospital that we have brought in travel nurses.   This is my only hospital I’ve worked in, and like I said, my only experience with travel .  Am I missing something?  Are we expecting too much of the RN?  Yes, our ideal modality would be 5-6 clients, but right now, because of the nursing shortage, it’s not a possibility.

Two words:  Not Impressed

 

Hindsight is 20/20

 

Have you ever just done something without thinking?   Then right, just as you do it, something in the back of your head says, “STOP”  but you just don’t listen and keep on going?  Then you look at the result of your actions and think WTF did I do?  Yeah . . .

I decided to paint today.  I have this cabinet that I bought a few years ago at a garage sale for $3.  At Wal*Mart I found some black paint on clearance for $3 an a can of that “stone” spray paint.  Mind you, I’m a quick result, quick response person.  I grew up with a microwave, where you can get a full complete 3 or 4 course meal in 5 minutes.  I can download and entire song in 2.3 seconds on my cell phone.  My bank gives you $5 if you aren’t through the drive through in 5 minutes.  Quick results.  Quick response. 

Painting does not fit into the quick results, quick response area.  It was fun painting at first, then I realized that I still have 3 sides to do, plus the drawers.  I rotate painting and spray painting.  Which just gets spray paint over my paint.  So I repaint.  Mind you, I’m doing this in my dining room, yes inside my house.  Again, wtf was I thinking.

As I paint, stroking and stroking, up and down, wax on, wax off, I think, “geesh this paint is thick.”  Thick and shiny.  Thick and shiny.  Wax on, wax off.  Finally, done.  I’m satisfied with my work, except I’ll need to do another spray paint coat outside tomorrow.  It takes me all of 15 minutes to paint, quick action, quick response.  If I really had wanted it to look nice, I would’ve had my mother-in-law come and paint it, which would have taken her, eh 2 hours maybe.

I take the brush into the kitchen and turn on the hot water to rinse it out.  I take my hand and rustle the bristles.  STOP!  Ohhh, I heard it, but kept going.  Pure black, glossy, enamel paint.  All over my hand.  What do I do?  Ohh!  Take the OTHER hand and rustle the bristles.  STOP!  ohhhh damn.  Literally pure black hands.  Both of them.  Damn damn damn. 

Thankfully Mike had taken the Baby to pick up the Dude.  The Man was playing the x-box, so it gave me time to hide my mess before Mike came back home (only to make fun of me).  Palmolive cuts grease!  Two uses of that, no luck.  SOS!  Yeah, one large steel sponge, a bit better, but no luck.  I jump into the shower.  Irish spring, no go.  Pantene, nope.  St Ives apricot scrub, gets some of it off.  Toss on the burgundy Victoria’s Secret robe that my husband wears as much as me, and take 309,855,309,258 cotton balls and all I have left of nail polish remover.  It takes off most of it.  I still have black hands.  Hopefully it will wear off before I work this weekend, or before clinicals on Monday!

 

Quite a handful

 

While assessing a client’s radial pulses post I&D of the elbow, I reached for the operated limb, checked and then reached to the arm across the client’s  stomach.  I grabbed his wrist and realized he had a handful of, well himself.  He non-quickly let go and offered his arm, but I passed.

 

Surgeries

The other day while doing a history assessment of an 80 year old man, I asked him to list all the surgeries he’s had in his entire life.  He said, “My entire life?”  Yes please.  “Well, when I was 3 days old I was circumcised.”