Ohhhh, the Agony.

Dilaudid. Percocet. Morphine. Fentanyl.

The four most common painkillers I've seen thus far administered to patients in my hospital. I have never taken any of the above, but supposedly, they work pretttttty well. I've seen many reactions, some sleep for hours and hours, some go into la-la land and act like they are 5 years old and don't remember any of it, and I had a patient yesterday who went from being a not-so-social elderly gentleman to a guy that suddenly was talking my ear off, thanks to dilaudid.


In this day and age, hospitals are so drastically focused on their ratings, their scores. With so many hospitals being built in this day, patients now have the ability to choose (if they are lucky and its not an emergency) where they would like to be a patient. Smart patients check the hospitals scores before they choose. How does this hospital score in cleanliness? In nosocomial infection rates? In service? In food? How about pain management. Well, lately hospitals have been noticing a decline in scores because of one thing: Lack of effective pain management.

Okay, so then what? Well, hospital management teams revolutionized their thinking. We know now that a hospital is a business. Patients are the "customers", and as the old saying goes, "the customer is always right". So in our book, the patient is always right. This has been brought down to nursing care so much so now that we are trained to always ask about pain. We ask when we take your vitals. We ask when we stop in on rounds. We ask when we take you to the bathroom. We ask in the middle of the night when we switch your IV bags. We ask so frequently that sometimes I think we plant it in your head that you do in fact have pain!

I'm all for effective pain management.  No one should have to bear unmanageable pain for any length of unreasonable time. But sometimes we as nurses (and doctors) will never truly know if you are having pain. I have had many different types of patients: Those that I think are in true pain but are too proud to admit it and needing a painkiller, those that I doubt the true pain and yet are on the clock the minute they are due for the next dose, and I've had patients that fabricate ailments just to get a pain medication ordered. The other day I had a young gentleman as a patient with a bad case of cellulitis. It really did look painful. He had Morphine and tylenol ordered. He started complaining of pain, and I asked- Do you want your morphine or tylenol? To be honest, given his age, I half expected him to answer Morphine. But he actually said- "I took morphine last night and I don't want to overdue it. So I think I'll go with the Tylenol today." I was pleasantly surprised.

The other week we had a patient on our floor that, in the middle of the night, complained of awful pain in her chest. Being chest pain, of course we have to go through all the steps to diagnose the cause of the chest pain. We need Oxygen, we need chest x-rays, we need respiratory therapists, we need doctors...etc. Well eventually they gave her Morphine and she was as happy as a clam, went to bed, and the pain never appeared again. Now, did she have the pain in the first place? Maybe. Probably. But who is to say?

Recently I had a patient who was addicted to Fentanyl. So addicted in fact, that she overdosed. While in our care, she also came down with severe chest pain, and shortness of breath. Well, her team of doctors were hesitant to give her anything too powerful for the pain because of her history of multiple opiate addictions. However, what if the pain really does exist? We couldn't let her suffer either. So, we found a painkiller that is effective and less addicting (much to her dismay- she was after Dilaudid) and ran a chest x-ray. Turns out she had a pretty bad case of pneumonia, so the pain really did exist.  

I've had patients that are fine all day and then when the doctor comes, suddenly they are keeled over in bed and in agony, asking for pain medication. And then the doctor leaves, and then they are on the phone talking or watching tv.  And the best we can do, as nurses, is to therefore document what we see, what we observe on the patient, all day. The doctors read that. They read when we write, "patient resting comfortably in bed, denies having any pain", or "patient complaining of severe pain in mid-upper back". And its critical that we document that we followed through with that pain, and document we gave them something and what the reduced pain level was after. Its all about documentation.

Just a year ago, when I spent a week in a hospital myself, I was having some severe migraine pain (thanks to lack of sleep, stress, anesthesia recovery, etc). Well, they gave me a medication for the pain called "Toradol", which, is one of the ones that is pretty strong but not addicting. I guess given my age, they went with that because it was less addicting. However, I didn't even know anything about Toradol- all I knew was that I was in pain, and that helped the pain. Did I want the toradol when I wasnt in pain? No. Did toradol make me feel like I was on a cloud? No. It made the pain go away. Thats all I wanted, and thats all I want for my patients.


I've also encountered the situation many-a-times when a patient is dying, like literally on their death bed, and are in a lot of pain. And then the doctors are afraid to give powerful painkillers because they are "addicting". That drives me crazy! So what! They are dying and are in pain! Who gives a flying shit if they will be addicted? It won't matter! Get rid of their pain for crying out loud, no one should die while in pain. They fight over that and yet give Fentanyl to 20 somethings. Go figure.

Just recently I had a patient with a severe leg injury that resulted in a very large hematoma that had formed into a very grotesque blister, bigger than two of my hands together. It looked really painful and I was constantly asking if he needed anything for that. I would have given him something in a heartbeat without question if he asked. And then we have the all to common patient with "invisible pain" (abdominal pain, headache pain, muscle pain, back pain,etc.) And I don't think they are lying, they probably do have pain. But it definitely is a fine game to play. They probably thought when I was in the hospital that since I was a young twenty something, I was making up the migraine and was looking for some painkillers while I was there.

So, just goes to show that there is no way to truly know. We as nurses want to give effective care. So if the patient is in pain, we administer pain medication. It is not up to us to judge whether or not they really do have pain or what their ulterior motives are, if any. We just make them feel better.


With love,

A Writer in A Nurse's Body

Who Would You Be?

I'm a girl. In case you didn't already know that. I chose nursing as my primary profession, and artistry as my secondary. Makes sense, right? Kind of...the norm? Lots of women become nurses and lots of nurses are women.


But would I have chosen differently if I were born a male? Yes. I would have definitely gone into architecture, or construction. Something to do with my hands, drawing, and math all together. In fact, architecture was my first choice of profession but at the age of 17, I was frightened by a profession dominated primarily by males...and *business suits* (ew).  So nursing it was.



That is not to say that If I were male, and still had my current personality, that I wouldn't make a great male nurse....I would. But would I have ever even considered nursing if I were male? Or did I consider it because I was female?

It's interesting to think about. What about you? Would you have chosen differently if you were born the opposite sex? Are you an uncommon gender in a profession dominated by the other gender? What made you choose that?


I wish we didn't live in a society where jobs are still "genderized". But we do. We probably always will. However more and more males are coming into nursing and I support them 100%. I think, 98% of the time, males make great nurses. Chances are if they are a guy and chose to go into nursing, they are also compassionate men, caring, sensitive and loving too, and yet have the male features of being good under pressure, assertiveness and getting things done fast. I wish men weren't so afraid to come into the profession because they feel they are outnumbered by women. And it is true, they are severely outnumbered. At my current workplace, I work with ZERO coworker male nurses. I have worked with three over the course of the past five years, but only zero currently. The only males around are......can you guess it? Can you? Yep. Doctors.



So, men out there job-less or in high school and don't know where to take your life, consider nursing! Consider the benefits for you:

- you get to be around women alllll the time. And nice women (mostly!) too.
- you (usually) work 3 days a week, 4 off.
- you can travel anywhere and still be a nurse
- there has got to be over 10,000 different types of nursing positions, all with the same degree

And there are other reasons too I swear, Im just exhaustified and need sleep and my brain power stopped at exactly 7:30 when I got off shift tonight.  But really guys, we need you!



Look for another post coming tomorrow! For now,


~WNB



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Week Two as an RN: Getting my Legs

Would you believe I have seven blogs in draft mode that I've thought of in past week, and this is the first *spare moment* I've had to sit down and even start the first one? (This one). It's been absolutely insane!
Well, I survived week number two as an RN, and boy..........have I learned and done a lot. Tomorrow it starts all over again, three more days. This past week I've had a very interesting set of patients, as well as having practiced continuity of care. I started the week with two patients and kept one of those two for the whole three days.


I ran into a lot of problems, but was able to solve them. I'm running head first into a lot of "oh my god I can't handle this!" type moments, but the important thing is learning that they ARE going to happen everyday no matter what and no matter how experienced you are. The important thing is to take a deep breath, close your eyes, reprioritize, and get right back to it. As long as you constantly reprioritize and act with the best intentions, you can't go too wrong.


So that was my second week. I missed things, yes. Things fell through the cracks. But as the week went on I learned from those fallbacks and made sure the next day to not let it happen again. As much as I hate making mistakes, in my opinion-bring on the mistakes now while I have a preceptor (rar!) who can teach me the right way, rather than in a month when I'm on my own on nightshift. The worst thing you can do, and something I am faulty of, is trying to figure out something on your own. The hardest (and easiest, sorta) lesson to learn is knowing when to ask for help. To put aside your own pride and dignity for your patients sake and safety.


Its funny, those frazzled moments....You start off your day with everything calm. You get there, get report, organize all your papers, make to-do lists, draw up your AM meds, do assessments....and for the most part its pretty calm. But then, then the frazzle moment happens. Its been a different time of day each day so far for me. Sometimes its 10am med pass, sometimes its a random point in the day at 2pm, or sometimes its right before we leave, in the evening. The frazzle moment is when you HAD a plan, but somehow that plan was thrown out the window, and replaced with four new plans, and everyone needs you to do something. But not only do they need you to do something, but they ALL need you to do it right away. And its hard to prioritize when they all want you at the same time, and you have to figure out who to make wait and who can't wait.

But, talking with my staff development educator after one of these frazzle moments helped me learn something else: Knowing when to delegate!  I explained to her that I was having a hard time with that, because the aides on the floor are my friends, and its hard going from working with them to now telling them what to do. She noticed I was having a problem because I was trying to do everything myself for my patients. Things aides can do, and my own nurse work, and thats where everything was getting to be too much. So, have to work on that.


But, I'm really excelling in my skills. The hardest part so far has (still) been communicating with doctors, and prioritization. But, that will come. Every day I learn something new! :)


So, exciting news?? I got in my first IV!! on the FIRST TRY!! WOOT!!! It was pretty amazing, and I really had to restrain myself from literally jumping and doing a dance in front of the patient, but I refrained because I didn't want to further help clarify that it was my first time. I think she was already nervous enough as it was. But yay! But despite having done one once, I'm still nervous for # 2....Is that normal? :\


Needless to say, There has been a LOT of prayers coming from me this week. I have levels of prayer...some are just mere wishes, like, "I hope the cafeteria has chicken sandwiches today".....and some are level 1 prayers, like: "please let me have a good day today." Level 2 would be, "please let work, please let this work!"  and the ultimate......Level 3: WHen you hear the beginning sound of a code when you're on your lunch break, "For the love of GOD, PLEASE don't let that be my patient!"


Lets just say a lot of Level 3's have been entering the prayer (center? Receiving area?) from me.



But eventually they will fade. In a couple years, I won't need prayers answered, because I will know how to do things myself rather than rely on chance and fate.


Also, I got to use my "therapeutic communication" skills (or lack thereof, I really don't know). I was sitting at one of our more secluded nurses stations, by my section of patient rooms, and a woman (visitor) came outside of a room.  I looked her way, we made eye contact, I smiled, and went back to charting. But then I registered that she was crying. I looked back and asked if she was alright. She nodded, but clearly wasn't. So, even though she wasn't in my patient section, I'm not about to just continue sitting there while she cries in the hallway. So I closed my charting, walked over next to her and told her that although her loved one was not on my patient section (and therefore I couldn't answer any questions) I'd be more than willing to sit and talk with her if she wanted. She agreed, and explained to me why she was crying (it was a really sad story :( ) and so....with all this sadness..I didn't know what to say, but who does? I tried to remember all the things we learn, that silence is golden, and people like hugs....So I tried to just stand there with her and not say anything, and when it was time to say something, I just tried to say encouraging words and encouraged her to talk more. Hopefully it helped some and I wasn't an intrusion.




So, here's to a new week ahead! The most important thing is to learn from my mistakes and learn something new every day. :-) I need to invent a portable screeen of some sorts that follows me around and my tasks to do get added to it and things that ive done get added to it on a time schedule, results come up right away, orders.....and so when you do something on the to do list, you can virtually cross it right off and the computer prioritizes for you whats next. We could all be super-nurses! Until the machine breaks....lol.




With much love, WNB.



PS- I have like eight more posts to write, so keep an eye out for them coming up soon!



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Fall Sun

The best kind of sun, the best heat, is on an early fall day.

There is no humidity.

In fact, it's a little chilly out even. There's a nice breeze going and you can kind of even smell apple cider in the air mixed with pumpkin.

You sit outside, radiating in this bright brilliant heat. It beams down on you with such intensity, it soaks through your clothes and long sleeves to create this happy warmth now encased in your skin.

It encircles you, protects you. It's not too hot, just enough to wrap around you to replace someones arms that you love. Enough to temporarily replace their body heat around you.

And thats what i love about the fall sun.

What is Heaven?

I'm writing a very important book. Its going to be so ridiculously involved that despite planning since high school, I'm still planning the book. I have a couple scenes written but nothing extensive. A big question that revolves around the center of the book, is, what is heaven?


My answer, and one of the answers of many that arise in the book, is that heaven is many things, and heaven is different for every single being on this planet. Heaven is what you want it to be. Nobody is not happy in their heaven.

I don't think that you necessarily design your heaven. You don't sit in a waiting room and pick out everything you want and the architecture of it all and then you wait for it to be designed and then you go....I mean of course thats a possibility, but I think it runs more along the lines of you arrive to heaven and everything is just...exactly the way you want, even things you didnt even know you wanted until they were yours. Heaven doesn't have to make sense. For example, I hope my heaven is a bookstore that extends for miles and miles and miles and there is a neverending string of books. Outside the bookstore, if I so choose to ever leave, will be a beach, and it will always be just the perfect weather that I'm looking for. There will be a little cafe on the beach, with lots of green tea always available. And rice krispies.

Next to this bookstore and a beach, there will be mountainous hills with natury birds chirping and sun shining through the tops of the wooded trees...in the middle of it all will be a lake, and a kayak for me to roam around in, take daily naps. The distant sound of children playing will be on the shore.  Next to all this even more so, is a cute little town from the 1950s, where everyone I need to see or want to see is there, and everything is perfect. Not necessarily the human standard version of perfect, but my perfect. Sometimes one persons version of perfect is what someone else considers a flaw. 



But, thats all for when we pass away from this planet. But what about heaven on Earth? Does it exist? My answer is yes.


Heaven on Earth is when you are lost. Sometimes actually, literally lost, but also--sometimes just emotionally and mentally lost. Lets say you are in the woods, on a hiking trail. You are by yourself. Maybe you do know where you're going (you're on a trail) but your soul doesn't really know....its sort of just in limbo, wandering around. You keep walking and walking and walking just to find something, anything. You start to hear some distant, happy voices. You have to make a decision..do you stick to the trail or do you seize the day and go see who those voices belong to? You decide to seize the day and you set off to follow the happy voices. Through some thick brush and thorny thorns, you eventually come to a clearing, a lake. The lake has a beach, with tiny rippling currents washing upon it. There are lots of people there, having a picnic, plenty of food. People are kayaking, canoeing, tubing, there are children laughing and playing and swimming in the water. They see you and gladly invite you to join. Grab a hot dog! They say. Or grab a kayak and go for it! They say. And you do. Because you made the decision to leave the boring trail you were on and you found this new....unexpected, place that you didnt even know existed. And now, you're here. And you're not dreaming. But it seems so surreal, so surreal in fact that you walk slowly and carefully, because you don't want to "wake yourself up" from this apparant dream. So you forget your life you left behind on that trail, just for the next couple hours. You know you'll go back to it. And you'll tell your husband, wife, boyfriend, girlfriend, son, daughter, mother, father, whomever, all about the amazing unexpected day you had. Or maybe you won't. Maybe you'll eventually return to the trail and that little cozy niche in the woods will always be your secret. Your secret place to go back to.



The other day I was driving home from Long Island, New york. It was the first sunny day after two hurricanes had graced their presence upon us. I was ho humming, driving along the boring highway (think about the trail), and was stuck in some pretty heavy traffic. All of the sudden, I look up and I see a sign for "Jones Beach, this way" so I made the split second decision (I literally thought about it and made up my mind in all of about 10 seconds) to turn the car that way. Once on the new highway heading directly towards the beach, I felt estatic! Free! I thought to myself, am I crazy?? What, I'm just going to go to the beach by myself and sit there and walk around and smell and feel the ocean.....yes! Yes I am! Who cares!? Despite having absolutely no original intention of going to the beach on my way home, there I was. I had been to this beach before, quite some time ago and it represents some very good memories with many loved ones. So it felt so good to be heading back.

Once parked and out of my car, I started walking to the water. There was just the perfect amount of people there. The perfect sounds. Seagulls, the waves, people playing some frisbee, splashing in the water. And just the wind was perfect even. As soon as I stepped onto that sand, I knew I had found a miniature Heaven on Earth. It was surreal indeed, and I wasn't sure if I was even dreaming or not. One minute you're driving home to New Jersey and the next you're standing on a beautiful beach, with your toes in the water, looking at the atlantic ocean.

I've encountered a few "heaven on Earth's" in my life, and they will always be treasured in my heart. Some I will never get to go back to, but will forever remain in my memory. But sometimes thats the best part about finding a Heaven on Earth- sometimes it only exists that one time.  If you try and find it again, sometimes you won't. Sometimes it will change. Thats the magic of it. Heaven is always changing.


Have you ever found a Heaven on Earth? Its different for everyone. For some, its under a car fixing it. For others its driving across America on a complete whim. For some, its taking the next flight to wherever and finding peace and a new life in that new town. It can be anything!

Here are some glorious pictures from my little beach heaven excursion:

With so much love,

~A writer in a nurse's body

Day 3 as an RN: Under Fire

Whew! So, lets go over this week.

Day one summary- Easy. "This job is awesome! I love being an RN! Woo! This is going to be GREAT!"

Day two summary- First patient. "This is great! I'm doing great! Running into a couple problems but easily solved. Helping out lots of others on the floor. Eager to learn more, do more!! Bring it!"

Day three summary- "WHAT THE HECK AM I DOING!!!"



And thats pretty much all I need to say. But I'll say more- have no fear, thats why I'm here.


The biggest lesson I learned throughout reflecting on the day (I actually learned it during my lunch break when I literally just sat there staring at the wall, breathing) was that although the day thus far had been CRAZY and there were MULTIPLE times I literally thought in my head, "I'm not cut out for this. I am in over my head, like way in over my head, and I cannot do this", I do realize that I DID learn a lot yesterday because of that insanity. Not only did I learn true prioritization and time management, but I will remember the skills I learned forever. It was all very fast and in the heat of the moment (s) and it was either do it or you don't do it and the patient suffers.

I guess what I'm confusingly trying to say is, I learn better that way. Under fire. When you really don't have time to over-analyze it, (but still enough time to do it the right way!).  If my preceptor is going to just calmly be like, "Okay, step one, you do this....and step two, do this..." and I only watch, and its all hypothetical, then I might learn that in the back of my mind but its not truly ingrained. Whereas in the heat of the moment, you remember everything that you did. Did it work? Okay, do it again that way. Did you run into a problem? Did you learn the right way to do it after that? That, you will remember forever. I guess I learn best via trial and error.


But anyway, I got through. And by the end of the day, I did everything I was required to do. I swam through the deep end and made it to shore. I got everything squared away with my complicated patient, and even had time to volunteer to do another nurses admission assessment, despite it being my first time doing it, I thought, "How hard can that be? The computer guides you through the whole thing." So I got to do that, that was cool.


Update on the doctors...I got to deal with a new group of doctors yesterday, well, residents really. Which was excellent. The residents are so....eager to help it seems. They are still learning so they are still so genuinely interested in their patients and actually like when you call them. And I even got to meet the resident bunch when they came to do rounds on the floor and I met the actual one I was doing most of the talking with on the phone, and I redeemed myself and made sure to not come across as a total newbie/idiot. So, cool. Getting practice....eventually calling them will be no big deal. Eventually!


I also encountered my first family gathering/update/education session....twice! My patient was 94 and with severe dementia so not much education was happening with her. However, midday someone came up to me and asked if I was the nurse for that patient. I said yes, and she introduced herself as the daughter-in-law and had a couple questions and wanted an update. So I gave her an update and suprisingly answered all her questions! Somehow. So, that turned out alright without any prior "prep time". If I had known she was coming I would have read through the chart furiously and gave her the best possible update. But I told her what I knew. And then a couple hours later, I was informed that the son was in the room and wanted to speak with me. So he had some more questions, which I was also able to answer all of them! I love love love finally being able to answer questions from families! Its been so annoying these past five years reciting, "I don't know, let me get your nurse."  Woot!

I went to a meeting at work, after my shift, that was all about how to handle angry patients and how to make them happy again so they pretty much don't leave our hospital saying they would never come back again. But point is, the speaker made a really good point that shed some light on my work and probably a lot of others, too. Despite how bad my day is, on my worst shift on the worst day, I am doing good. I am helping people. And, I get to go back home at night. I'm not stuck in a hospital bed, waiting for biopsy results, or listening to my IV beep, away from my family. No matter how bad the shift is, your patients day is probably worse. So an interesting perspective to think about when I feel like I am having the worst day.






Well, I have the weekend off! So, lots of drawing, some photography work, and maybe some writing I hope!! Yay!



Thanks for reading everyone,

~WNB

Day 2 as an RN: Overcoming Fears

AH!

So.....day 2. I survived. I'm still sort of gathering my thoughts....


I got my own patient! But he was not complicated at all, and all I got to do with him was some education, an initial assessment, lots (and lots) ((and LOTS)) of meds, IV meds, piggys, primarys, subqs, and other fun stuff like that. Felt *just* like I was back in clinical. Which is OK.....because at least I don't have my intimidating teacher looking to fail me anymore. Now I have a preceptor trying to teach me and make me a good nurse, and she trusts me (probably a little too much) to do a lot on my own. So, thats good.


The biggest hurdle I have yet to cross is getting over whatever I fear I have of doctors. Okay, It's not that I'm afraid of doctors. It's just in my personality code that I:

1) hate to bother people
2) hate to talk on the phone
3) have trouble understanding diction...especially heavier accents =\

So,  ^^ all that is pretty much all doctorness. I don't mind at all talking to doctors in person. I am a very personable person and I understand nonverbal communication so much better than over the phone. I don't care if you are furious with me, I'd still rather talk to you in person than on the phone. I hate the phone. Hopefully that will change. That has to change. Nurses are on the phone just as much as they aren't.

Today I was only working with one doctor since I only had one patient. Luckily I got to see him on the floor so I took advantage and snuck in there and got to introduce myself while asking him to change a patient order (that sounds so awesome and nursy official but it really wasnt lol). And so then a couple hours later I had to call him again and get an order verified to continue it. Well, I did not want to call him. But my preceptor felt it was time I get over it and get on the phone and start calling the doctors. She reminded me that if I don't call, then I'm not looking out for my patient.

Luckily during our quick 40 second phone conversation, I didn't say anything too entirely stupid, I understood him (most of the time) and I got what I needed.... But it was still not preferable.

I guess at this point its just a matter of learning what each doctor is like, their personality, when you can call them, when you can't, what you can call them for, or should you call their intern? Funny thing is night shift won't be so bad because unless your patient is dying, chances are the residents will take care of what ever you need. And the residents/interns are usually closer to my age, just as clueless as me, and in the same boat (ok different boat, but similar), and we work together. Together is key. If were both equally as clueless, lets work together with our different knowledge bases and solve this together!


Anyway, my other hurdle is putting in an IV. Tomorrow is day 3 and its about time I at least attempt my first....so, I'll update on that tomorrow. =\

It's funny how in nursing school my biggest fear was anything to do with the IV system. Piggy's, primarys, tubing, or whatever. My teacher always made it seem to frightening. But now I love working with them. It all makes perfect sense now and I don't understand why I ever thought it was scary. So, thats good! I knew I would get my technical skills down fast, its just a matter of learning reasoning behind actions, remembering everything, doctors, knowing what to do in emerging situations, etc....it will all come with time, I hope! It's only day 2 and I think I'm expecting my personal performance to be at day 124,111,293. I'm a perfectionist I guess and I can't sleep at night if I know I did something wrong with, on or too my patient. So I also have to learn that mistakes do happen and thats how we learn and become great nurses. And, no one is perfect on day 2. Right?


So, tomorrow, pretty much just a repeat of today except hopefully can do better, be more on top of things, and hopefully get my first IV stick.



Thanks for reading! To my non-nursing affiliated readers, I am sorry! I hopefully will come out with a non-nursy post soon, this weekend perhaps. What would you like to hear about? A funny story? Some photography? Writing? Just an update on my life? :-)



~ WNB < 3

Day One as an RN: The Blue and the Green

WOW!

Where do I even begin??  My first nursing shift was today......7 am feels like it happened five years ago!

So much to say, I guess best place to start is the beginning?


So 7 am. I was as nervous as a jumping jelly bean. But at the same time.....kind of calm. Does that make sense? Nervous because I was starting a brand new, huge, important job. But calm because I was in a familiar setting with people that love me, and I kind of knew what was ahead of me. I was ready for the day. Thanks to my incessant and annoyyyying adhd, I just really wanted to get OUT there and start doing something. Getting report is essential, and great, but I'd so much rather just get out on the floor and go see my patients with the night nurse rather than sit at a table far away. The nurses on my floor used to walk & talk but we seem to be straying away from that thanks to hippaa (privacy laws). So now we give reports in little hushed corners where no extendable ears are listening (supposedly).

So first things first, I got acquainted with my preceptor and we sort of laid out the ground rules and what not. Today was strictly  (supposed) to be an *observation* day. Remember that, lol.

After that we got right into assessing our patients, one by one (we had four to begin with). Well, my preceptor quickly realized I was not about to just stand there all day and so she let me listen ( to bodyish sounds), assess, chart, etc. Then came time for meds. Normal meds. Since the med system at my hospital is something I'm totally new too, this took some time to get used to. As an aide, I was pretty much familiar with most everything else nurses do (like IVs), but meds and the medselect system was kind of foreign.

But then the "plan" went out the window. And soon after is when I learned that plans are great in nursing, but last for about five minutes before everything gets uprooted and changes again. One of our patients started having intense chest pain, so that took priority above everything else, even though we had all our meds laid out and ready to go on someone else. So that required a full asseessment, a stat EKG, doctor phone calls, labs, etc. After all that settled, we went back to those original meds for about five minutes before one of our other patients (psych) pulled out his NGtube (really not good) so we had to go rush and reinsert that. We got temporary placement, but when it came time to give him his meds through the NG tube, it was clogged and we couldnt unclog it and therefore we got to reinsert a new one.

So, phew!

After that we went back to the routine meds, and by this point she decided I had picked up fast enough that she let me draw up my own meds to give. Woo! So the rest of the day was a collection of lots of meds, working with a lot of IV's, charting (a lot), and reassessing. I learned a lot more about prioritization, and learned that there is just SO MUCH to do. 12 hours seems like such a long shift, but I'm starting to realize that its not even enough time to realistically do it all! Yes you have to always attend to the emergencies first, and then after that attend to stat orders, medicines, assessments, etc, but if you leave patient communication on the backburner or turning them every two hours, then that will slowly creep on you and it will soon become your worst enemy if you don't attend to it first in the beginning. So Nursing is a game of knowing how to do it all, at the right time. I get that now. I just have to perfect it.


So, whats with my title? Well, I've changed colors. Aides wear teal green throughout my hospital and now I'm wearing royal blue, along with all my other nurses. Its funny- All day I got a lot of confusing stares-even from the cafeteria workers and housekeepers- that I was "in a new color".  Sidenote: As much as I love the thought of self expression and coming to work in whateverhellscrubsyouwant, I do enjoy being able to go to the cafeteria and know where someoone works and what they do based on the exact color they wear. What do you think? End sidenote. lol.

Anyway, since I haven't been to work in like an entire month as an aide (thanks to NCLEX and the law), there have been a couple new hires (aides). And when I had some down time today (my preceptor went to lunch), I made some rounds in the hallway on everyones patients and went in and helped a couple people to the bathroom, answered a couple bells, etc.  Well, you should have seen the look on one of the new aides face when she saw me in the room, helping one of her patients. She doesn't know me and all that ran through her mind was, a nurse is helping me? Fo realz? It was quite comical.  Even some of my closer friends that are aides, I can tell they see my blue now and I can read their thoughts. I can practically read it in their eyes, hoping I don't become "one of them". One of those nurses that doesn't help, that is bossy and "too good" to clean out a bedpan, too good to help out wherever its needed. All I want to do is prove to my friends that just because I wear blue now doesn't mean the past five years as an aide hasn't taught me anything. Those five years are the entire backbone for the nurse I am today. I would *never* be where I am today without the experience, and without those friends to get me through. To get each other through.


But it is hard, separating myself from that role. Despite me wanting to prove I am not "that nurse", doesn't mean that I don't have a whole new set of responsbilities now that need serious attention. Sometimes you just have to delegate, and I see that now too. Thats where excellent communication comes in and treating your aides right and they will treat you right! :) But even just instinct. THe sound of a call bell- I still automatically start walking towards it. The sound of an emergency bell still makes me want to run. Today I felt like a bad person because I was giving meds instead of helping whoever was trying to get out of bed when the emergency bell went off and the aides were busy. I remember those days. Its hard going from being responsible for the entire floor to only responsible for 4 of those people on that floor of 30. Its a lot different.

I have full intentions on telling my aide(s) every day how much I appreciate their help. To say thank you for every thing they do and take nothing for granted, ever. I will never delegate a task that I could just as easily do if I am not swamped with charting, meds, ivs, etc. I will ask them with respect to help me with something rather than tell them to do something for me. I think every nurse should be an aide first! I really do though.


So by the end of the day today, my preceptor discussed with me how she was superbly impressed with my knowledge base (trust me, I was suprised too), my instincts, memory and bedside manner. So, yay! So her and my educator decided I was ready to move along to the next step: my first official patient comes wednesday! I make the decisions and guide the care, give the meds, chart and assess, all under (a lot) of guidance from my preceptor. Woo! It felt AWESOME to be able to explain to patients (finally!!!) why they are going for a test, or why their lab values or up, or why they can't have a regular diet, etc. I've been so tired of saying, "I don't know. Let me get your nurse."  Now I feel like everything makes sense!!!

I think I am most scared of: calling and bothering doctors (they always seem so bothered when you call), and putting in my first IV. Yikes.

Also, by midday today I wanted so badly to just practice what she kept teaching me. I just wanted to grab it and do it myself! So thats a good sign. At least i'm not afraid to do things. I remember in clinical I thought it was the end of the world if I had a patient with a piggyback, because I was afraid of it. Now I find it exciting! But then I finally DO get in the spotlight and asked to do something and then all the confidence leaves and suddenly I doubt all my actions because I am just so deathly afraid to do something wrong.


At this point, its all about finding my own "system". What works for me? What charting system, what assessing system, what medication system works best for me? How should I organize/plan my day? So it will take learning from a couple different nurses to find out which techniques I want to take from who and mold myself from that.


Well, thank you for reading this far. Really! Even if none of you made it this far, I'm glad I have this all in written form because in twenty years I will read this entry, my first day of nursing, and I will laugh myself silly most likely. Oh how things will change! But I can't wait :-) Let life begin!



Love you all,

<3 A Writer in a Nurse's Body

Never Forget, Forever Grateful

Today is a special day. It will always be a special day. A day of remembrance. Remembering our countries heroes that didn't even know they were going to be heroes when they woke up that morning. Things were normal, it was a nice day. Typical day at work, typical flights, typical day at the firestations....until everything changed. The whole world changed.


Today marks ten years. I was in eighth grade then and still remember vividly every minute. I remember being angry, confused, scared....I am blessed and fortunate to not have lost anyone that I know that day but I know people that did and I don't wish that on anyone.

9/11 is its own day now....It's obviously not a holiday but its a day en grained into our brains, into our calendars still. The eleventh approaches every year and we go through the same feelings every year. Every year, the country becomes a little more quiet on this day. We all become a little more patriotic. A little less violent. A little more tolerant of each other. A little more appreciative. A little more grateful.

Two years after, on 9/11/03, I was a sophomore in high school. In English class we were instructed to have a freewrite session documenting how we felt about 9/11 or our memories from that day. So today I dug it out of one of my binders at the bottom of my closet to share it. Because what better time to share than the decade anniversary?


Please note, at 15 years old, I certainly wasn't a fabulous writer. I chose to write about my memory of that day.


Hearing those horrific words actually being said made me stop in my tracks in the middle of the scrambling mess of students rushing down the hall. People were anxious to get home and find out what the heck was going on, find out the truth. Teachers were instructed to be quiet about it, but there was most certainly something huge going on. And what I had heard from a couple friends....it couldn't be true. It just couldn't.

Immediately I ran onto the bus and picked a random seat, in a daze. Pizza, I thought. I was just at the World Trade Center only two weeks ago, eating Pizza on the "top of the world". Now its gone. Gone? All of it? How is that possible? My aunt Linda and I laughed happily as we strolled across that crowded cafeteria trying to balance our pizzas on our plate. We leaned against the glass looking down at the little ants thousands of feet below. Incredible. Its gone now, I cried.

As I got off the bus, I noticed a biker. I began to walk down what now seemed to be a never ending street. How could someone be riding their bike when I could barely move my own two feet?

It was hours before my mom got home from teaching that day. I hid up in room in the niche of the wall, hiding from the happy sunlight pouring through the window. How could we have such sunlight here and have New York City in the dust? Shouldn't we all be in the dust now? As one nation together that collapse? No. We didn't collapse, I thought. We were still American even if we have been pushed down. But we'll get up again, right? I could just imagine the thousands of hurt families grieving over what had happened, imagining the survivors breathing through dust masks, praying to get out, just to breathe. To be Alive.

Mom came in. No words said. We hugged the hug that wouldn't end. It won't end because to this day I can still remember exactly what she smelt like, and the formation of her tears falling upon my head.

The phone rang. I couldn't answer it. It was Dad leaving a message from California. He is all right.

Mom turned on the news. I stood in a trance watching the screen. You'd think it was snow if you didn't know better. So much debris was falling, falling softly.

I couldn't watch the tv anymore, so I went to sleep, expected to blink and wake up for a new day and this was all a nightmare. I wish.

I really liked the soap in the World Trade Center bathroom. It was noticeably nice soap. Now I'm forever haunted to ever admit ever again that I like soap in a public place.



The day will stay with us forever. But thats a good thing.  It teaches us new lessons. Never lets us forget, but keeps us looking forward. Its a day to thank our firefighters, EMS workers, policeman who did such a fine job. Who ARE doing such a fine job. They are our heroes, in my book.

This is my FAVORITE tribute ever made, as it really showcases how tremendous our firefighters/EMS/Police are. Gives me goosebumps!!


As nicely said by State Farm,

Never Forget. Forever Grateful.



~WNB

Morph up the Confidence

So today I got to go to something in my county called, "Victorian Days" where one of our small (old) towns transforms itself back to the Victorian Era and the townspeople dress up to the time period and they do Victorian type events and so house tours, etc. It's pretty neat!

Pictures from the funtastic Victorian day:

So yay! But thats not the point of this blog (post). This is:

Morphsuits!


So, living a kind of sheltered life (apparently so) I had no idea these existed! But, sure enough, at this VICTORIAN DAYS, two youngins (maybe? They could have been old I guess?) came out of nowhere, one came up to me and wanted a high five, and the other did a cart wheel and then they ran off giggling. I sort of was just flabbergasted and awestruck and I wasn't sure really how to react to that. Except, its kind of hard to surprise me, so naturally I sort of just kept walking like nothing happened. But on the inside my mind was like, whhaa?


So it got me thinking, as I watched these two....people...parade down the street, saying hello to people, doing cartwheels...high fiving, taking funny pictures....its all stuff they most likely would never do if they were identifiable. So it got me thinking (so much thinking going on here!) what would I do if I were unidentifiable? If no one would ever know it was me? Completely anonymous, and yet so very noticeable? It's easier to be silly, easier to be confident, and playful....


What would you do if no one knew it was you? Kinda sounds fun, doesn't it?

Part of me says I would never do it because I'd be too embarassed....but...thats silly, because no one would know! Hmm.....maybe one day! Thing is this is the first time I've seen this in America. Am I just that sheltered or is this a more European thing? Hmmm..



~ WNB

Contagion

Okay.


So, despite the fact that I do occasionally like to do movie reviews, this isn't exactly a movie review. But it kind of is. More so, it's commenting on the fact of how real it is.




First of all, go see the movie so you know what I'm talking about. I will *try* not to give too much away after this line but you never know. Just go see it. For those of you that are squeemish, there's only one squeem-producing scene, the rest is all fine to watch.



Okay so the movie centers around the fact that a strand of the avian influenza virus has struck the human species, in a form that is transmitted from human to human, rather than just bird to human. Being the fact that humans are usually so social and we are obsessed with touching so many things, any human contact transmission disease/virus spreads like wildfire. Also, thanks to how fast we can travel nowadays *and* how travel weakens the immune system of those travelling (lack of sleep, lack of nutrition, new environment/new bacteria/crowded air-bus-train travel), its sure-fire that the world would be just as much if not more danger than the movie actually presents.

In the movie, the virus starts spreading like wildfire. First 2, then 4, then 16, then hundreds, then thousands, millions, and so on (Which is how it would happen in real life). Then the CDC & WHO take notice and get involved and naturally, send out officers to try and figure out the root of this virus and to stop it (which would also happen in real life except a lot more than 3 main officers would be on the case).


But then news gets out. And thats when things go sour. People start panicking. Panic is contagious in and of itself. One person panics and suddenly no one knows what to believe. Think about it, you leave your house and you're on your front porch. A stranger is running around outside screaming in terror, running in the other direction. Wouldn't that make you a little panicky?

So, panic + human race makes greed. There is simply too many people in this world and not enough supplies for everyone....and thats with things running smoothly! When worldwide disaster strikes, everything shuts down and suddenly no one knows what to do. Food? Water? Electronics? People start raiding stores. Some for basic necessities, others in pure greed and opportunity to loot. When stores run out, people start breaking into peoples houses, stealing from one another on the street. And in the case of a worldwide epidemic, the support you would normally turn to, is probably sick. The police are sick, and even the healthy ones are probably not going to try and battle the crazed streets, risking their lives and risking getting sick and bringing it home to their family. So chances are the cops are out, the healthcare, emergency squads, firemen, etc. So then it's every man for himself. Unfortunately. Especially with a pandemic, it gets especially tricky. You want to trust your neighbor, but suddenly you can't trust anyone. Everyone but you and *maybe* your family is the enemy. Anyone could be sick. So people can't even bond together and fight and help each other out until proven immune.


And then the vaccine or cure of some type comes out. And then it gets even worse.  People kill each other to get their hands on it first.


So, it could happen. I've been learning about the possibility ever since nursing school and since then I've been worried, because now I know how easily it could happen and how unprepared we are as a nation and as a planet. I don't think our hospitals are ready. I don't think the country as a collective average whole is educated enough to know the basics of what-to-do and what-not-to-do during this type of pandemic. And when its already happening, its too late. Its too late to educate then, because during, who can you really even believe?


I have a gnawing feeling that despite everyone being worried about 2012 and the "mysterious end of the world" and the "sun exploding"  or "us being swallowed by a blackhole".....thats all possibility. But a pandemic is a pending reality. I think it could be the end of the world and people don't even realize it. The sad thing is it could all so easily be prevented. First prevention, secondary and tertiary prevention. I think if the virus/plague didn't kill us all on its own, the survivors would kill each other or we would all starve/dehydrate. It would be a pretty awful world.


So thats my depressing post. Overall the movie was excellent. It really depicts the reality of the situation and I hope it opens peoples eyes. People need to see what could happen. What will happen if were not careful.



Goodnight! Go see it !

~ A Writer in a Nurse's Body

IVing it up

Hi!


So, the much anticipated IV certification class was today! I still have not been on the floor during orientation because my state takes *forever* to get our license numbers, and the hospital needed to be SURE that I passed NCLEX. But, they finally got it today and I will be starting on the floor monday!! Ah!!! Look for a scaredy cat post Sunday night? Probably.

Anyway, today was the IV class, which I was actually really excited about. I've spent the last five years holding arms down for nurses and being literally right there watching them do every move. I've been taught by experienced nurses how to pick the best veins, how to get the good sticks, and I've watched the procedure done a couple hundred times, but never have legally been able to do it! Until now!

So of course the class was mostly lecture (a whole ninety-eight minutes!!!) and the whole time I was wiggling around in my seat because I just wanted to DO IT. Of course, the 5 hour energy I took before the class probably didn't help that ( I literally almost ran into the building because I was so excited).

Because I couldnt wait to actually do it, I actually volunteered to go first and that is very rare. I am never the first volunteer. I'm usually hiding in back until I watch everyone else do it and mess up first and then I'll try. But I felt I had a pretty good handle on it and I wanted to dive right in.

For the most part, I got everything right! It's really just a matter of getting all the steps down and engraining them into your brain so that the order comes naturally. Its hard to remember all the little steps sometimes. And the hardest part sometimes is finding the right vein.


All that aside, I have the feeling that I will be one of those nurses that is really good at IVs and gets called by other floors to come do theirs. With a lot of experience that is. I probably just jinxed it by saying that, but I really do think/hope I'll be good at it. I've always had a "feeling" for those types of things, I'm good at sort of just....knowing...which vein to go after and I am pretty good at feeling others pain. 


So, yay! Despite watching for five years and sucessfully sticking a plastic arm, I'm still undoubtedly going to be very nervous for my first human! I think its going to be more of a matter that the person will be able to tell its my first time, because I will have the natually tendency to be constantly looking to my preceptor for reassurance and thats kind of a dead giveaway. If I could practice on someone that doesn't mind that fact or is kind of unconcsious, then yay! (lol I'm such an awful person, i know).


So....monday it all begins. Get ready for some interesting posts!


~WNB

Clarifying the Pain Scale

Lmao! I just found this while browsing one of my favorite all time blogs, Weird Nursing Tales , and I literally cracked up laughing. Scrubs is a fantastic show and I miss it. They highlight the true humor found in the hospital that were all afraid to actually say half the time. Love it!! Oh, and this is so true about pain and how people react to it/perceive it!

Day bajillion and a half of rain here....New Jersey is apparantly the new Forks, Washington! Nothing but RAIN! It has literally been pouring all day. But I like to sleep to it, so I'm certainly not complaining.


Goodnight Folks!


<3 WNB

Reaching Out

Hey!

So my mind has been out of blogland lately....I've been trying, oh yes- But nothing in my mind has been posing itself as extremely blog worthy. However, if you miss WNB greatly, check out some of my pages above, I've been updating those here and there :)

It's been an....interesting...couple of days. I guess I can't blog much because all the topics right now I really just need to talk about, like just write and write and write my thoughts with no fear of anything....I can't talk about on here. Friends have suggested journals, but, I'm seeking a stranger to just vent to, I think. Like someone that is completely unbiased, someone that knows nothing already. Someone I don't know and never will know and therefore can't judge I guess...sort of? And if they do judge you, then you move on to another stranger. I guess thats the lure some people find in internet relationships? I've never done that but I can see why people do it.


But anyway, I feel like I'm trying to literally just do so many things at once right now, now that I'm not bogged down with overwhelming amounts of homework and I am "free" (kind of), I have so many projects I am trying to tackle. So for my own sanity and your entertainment, I'll try and list everything:

•  re-organize my room and get it ready for moving out this fall (YAY!!!) But this is seriously a huge project
• get all my writing in ONE PLACE. I'm really trying to get a major start again on my strongest novel, and I'm getting so excited about it because I'm getting so many thoughts for its planning and I just want to WRITE IT!! So, yeah. Thats another big project.
• Art, Art, Art. Not only just the drawing- that comes next. But painting too! I want to finish a painting I already started....and I want to try a new abstract style of painting that I can sort of visualize how its going to work in my head....I also want to start working with a new watercolor kit I bought to try and help teach me Watercolours. Yay!
• Drawing! Not only do I have like 2 huge architecture type drawings I want to get started on, but I have a lot of other random collections I want to do and finish. Amazing! Ahhh. Also, I want to start a real "exclusively Pixar-disney" portfolio, by taking screenshots from favorite movies and practicing drawing disney scenes.
• I want to try to put together, somehow, a LARGE portfolio, of ALLLL of my best photographs. So that they are all in ONE place. I'm sick of digging through computer files to try and find the one I'm looking for. So how am I going to do this? I don't know. There has GOT to be over 5,000 of these "best photos" between my high school shots, college shots, disney shots, Europe shots, random shots, etc.....So....yeah. Have to put some thought yet into this.
• I am swamped lately with photography work, mostly photoshoots for actors/actresses and some other random photoshoots. So lately I have been trying to do some work on renovating how I do photoshoots completely, but thats going to take a lot of work. I also want to renovate how my website is formed, as well as my photography facebook page. Whew!
• I am also trying to be a better nurse. Granted, I am a brand new nurse, but all the more reason to be the best one I can be. I am desperately still trying to read up on nursing literature in my spare time because I find it interesting (I really do!) and I truly do want to be a super-nurse.
• I really, really want to learn Latin. Seriously, though. I do.
• I need to friggen learn how to *actually* be a photographer.  

So basically, I will never be bored within the next...5 years?

I feel like so many things are within reach...but I am trying to be so many different people and by doing this, I can only do a so-so job in all. I am noticing myself slacking lately in photography, so I am only a so-so photographer. Only a so-so writer. So-so blogger. So-so artist. So-so nurse. But if i just had the time...if I could just pick one of these personas and stick with it, I could master it, but then I wouldn't be me anymore. I like that I do them all.....i just need about 16 hours more per day to do it all.  I want to be the super nurse, but does the super nurse have time for everything else I'm trying to do? I want to be an actual writer. I want to have this book written by 2 years from now. I want to be a professional photographer. I want to be an artist. And I don't even have KIDS yet! What's going to happen then???? I'll be a nurse and a mom? Or, stay at home mom and artist maybe? But I don't think I could let go of the medical side of me. I love it. I am beginning to really love medicine and I wouldn't ever want to let all that knowledge just dissipate. I want to make a difference in the nursing community. I have a feeling that I can do huge things and go really far.....I just have to reach. I feel like I can reach, but I'm not reaching. Because I'm afraid of failure? Afraid of success? Afraid of the unknown?


So...thats life right now. Wish I could just talk about the other 5,000 things on my mind right now. Yes, there is even more on my mind than everything i just gobbled out..


I really miss Thanksgiving. I am so, so, so so drastically ready for the winter. I miss cold. I miss snow, so much. I miss so much.........



Needless to say, this year is going to be very, very Interesting......In so many ways.



~WNB




 .

Sometimes

"There's just too much that time can not erase....."







This week has been absolutely insane. Like, no time to breathe insane. Literally.








:-\ Will get better soon.