Giving Thanks

I can't believe that it's Thanksgiving again!!  Time just goes by so fast.

It's been 2 years since this post...what!?!? And one year since this one!

Wow, happy 3rd Thanksgiving blog!  I know I enjoyed my fair share of turkey, sweet potato casserole, mashed potatoes, stuffing, and rolls...and more sweet potato casserole!  I hope you all did as well!

I will say this year has been filled with its fair share of disappointments and dreams not met.  BUT, it has also been filled with many things to be thankful for.

And today I am focusing on the latter-  the many, wonderful things to be thankful for including:

-My amazing, wonderful, incredible dream man who is not only my husband but best friend

-Having a new job that I completely love, and co-workers who make it even that much better!

Being able to take day                       trips...

...and long weekend trips

Long weekend Carribean cruise

 ...and unbelievable full out vacations!

Skiing in Colorado

Maui and Kauai

                      

San Francisco...

                                                                              and San Diego

 

and of course:

-best friends

-holding sweet little babies

-homemade creamer and a hot cup of coffee in a favorite mug

-reading in the morning with a great smelling candle

-laughing with Jonny

-holding hands

-my most cozy, fuzzy slippers

-stretch pants that can be dressed up or lazily worn around the house (yes, I am TRULY grateful for these!)

-enjoying a glass of red wine

-getting in a good hard workout

-cooking dates with my man

-and of course, my family!

Here's to another great Thanksgiving.  No matter what you are going through, no matter what your years has been, there is always something to be thankful for. 

I hope that you are able to spend this day with family or friends, and truly enjoy life's blessings.  And if you are a nurse working in the PICU, or any other unit, know that you truly are a blessing to your patients and their families!

Happy Thanksgiving 2012!

Questions Answered

Lately I've had questions coming at me from nurses that just graduated and are stepping into the APN world at work, from comments on my blog, and in email.  So I thought that since I had nothing to do this weekend (ha, yeah right!) I'd answer some of them now!

Question: What is the difference between being a nurse and an APN?
Answer:  I think this answer largely depends on what type of nursing you were doing, and what type of APN'ing you go into. I felt like starting as an APN I completely changed jobs.  Like, got an entirely new occupation outside of anything I ever knew! Yes, I still work in the same unit with the same people, but almost every single aspect of my job is different.

In the PICU it really breaks down to this: As a bedside nurse you are very hands on. You spend an entire 12 hour shift with the same 1 or 2 patients and so you get to know them very, very well.  You are focused on the "doing" aspect of the job a lot. As an APN you have more patients (usually around 6), and it's more like overseeing things.  You no longer "do" the things that you are ordering.  It is a bigger responsibility and requires more medical management knowledge. So less "doing" but more "knowing."

Question: So you're an APN...you must make a lot of money???
Answer: Ha, ha, ha, ha!!!!

Question:......

Oh, you really wanted an answer to that? My bad!

Umm, ok.  I think salary largely depends on where in the US you chose to work, and also if you work for a non-profit vs for-profit hospital.  I work in a non-profit hospital and compared to other places, get paid less. A few co-workers of mine actually took a pay CUT going from bedside nursing at better paying hospitals to being an APN at my job.  Go figure!

I didn't take a pay cut, but didn't get much more than I would have made at the bedside if I accounted for working 4 months of nights (which I now do as an APN).

Bottom line- you don't go into nursing in general if you are only concerned about the money.  The rewards of going into nursing are far greater than any monetary reward anyhow!

Question: Did you love being a nurse? Do you love being an APN?
Answer: Yes, and YESSSSSSS.  Loved being a nurse, but am seriously head over heels for being an APN.

Question: What was the hardest part of your transition?
Answer: If you asked me what I thought the hardest part of transitioning would be prior to starting I would have said adjusting to the new role with the same people around me.  Surprisingly, my co-workers, my peer nurses have made the transition flawless. I truly have gotten such respect from the nurses that I work with, and that has been amazing.

The hardest part of the transition has been trying to figure out how I can get the same satisfaction from the patients and families that I used to now that I'm not intimately involved with them at the bedside for 12 hours.  I'm still working on that one...I'll let ya know once I have it figured out!

Question: It must be so hard to work in a PICU. How do you deal?
Answer: Easy answer, I essentially have no hormones so it's against my nature to get emotional...that's not really a joke, but I think plays a role in my dealing, so there it is. But really, the true answer is part having to be attached while staying deteached. The other part is we really do see much more good than bad.  We have far more kids get better and go home, than die.  Many more miracles than devastation.  If there wasn't that last part, nobody would last long!

Question: What is your schedule like?
Answer: Again, this completely depends on what type of APN job you accept.  In my PICU, I work one weekend a month (or 12 per year, however I want to schedule them).  I work the equivalent of 4 months of nights (16 hour shifts, 40 shifts per year). I work 2 holidays each year (this year I "volunteered" for Christmas Eve and Christmas Day...stinks to be the newbie!). The rest of my schedule is filled in with 10 hour days, 160 hours per month.

Where I work, I have a lot of flexibility with scheduling which is nice. We have to get 160 hours in each month, however we want to do that. So if I wanted to work 16 days in a row, I'd have the next 14 off. Pretty simple...but who would want to do that!?

Question: How much do you drink weekly?  (I'm not kidding....my hematology APN asked me this when I first started!)
Answer: I like a good glass of wine. Or a dirty martini.  Funny though, the APN asking me this said, "Cuz if you don't drink now, being an APN will certainly drive you to!"

On that note, I need to get ready.  Its date night with another couple tonight, and I'm excited.  Pizza, wine card playing, and laughter cannot wait!

If I haven't answered your question, hit me up with a comment, and I'll be sure to post a "Questions Answered Part Dos."

Hope you have a lovely weekend.  And hope your job isn't driving you to drink...too much : )

Lumbar Puncture

Getting the opportunity to do procedures in my PICU can be few and far between sometimes.  Yes, we have a very busy 40 bed unit.  Yes, we have very high acuity much of the time.

But given that I'm one person, assigned to 6 kids (sometimes more, sometimes less) and don't work 24/7, things like doing central lines, intubations, and LPs just don't come along all the time.

Until this week!  I got to do my first lumbar puncture (or "LP" for my non-medical friends and family).

I got so lucky, because the Neuro Critical Care APN decided to save it for me.  It wasn't my patient.  But she knew that I was coming in, and she knew that I needed procedures.

Schooling to become an APN is great for some aspects, but certainly not great in getting in procedures.  So this was the lovely that I got to practice an LP on:

                                                                          [via]
Nice, right? And oh so lifelike!  Especially because the manequin that I was working on failed to actually have vertebrae..not that those are important for anything other than being the very cornerstone of placing the needle!

But I digress...enough with how school did not properly teach me how to do an LP, and back to the PICU that will!

The patient was 3 years old, super cute, and was easily bribed with chocolate pudding and mac-n-cheese (girl after my own heart!).  Until her parents left the room and she saw us putting on our sterile gowns and such.  Then it was all out freak-out, and really I can't blame her.  Although she had no idea what was going to happen, strangers wearing the get-up cannot be good in the mind of a 3 year old!

So after a ridiculous amount of sedation medications, the oh-so-still-slightly squirmy toddler was still enough for me to try.

I got my landmarks.  I numbed up the area.  And then I put in the needle. While it took a bit of repositioning, there has never been a more glorious site of fluid flowing out of a needle before!

And I must say that the Neuro Critical Care APN teaching me could not have been a better teacher.  She was so calm, so patient, and just so helpful.

The 3 doctors and 2 nurses watching me (not participating) could have left the room on the other hand! At one point, one of the doctors that I work with said "We are cheering for you! Just think of us as your cheerleaders!"

But really, who wants a bunch of cheerleaders in scrubs watching you as you put a needle into the spine of a squirmy toddler.  OK maybe someone who is attention seeking.  But that's not me.

So despite having an entourage of unwelcomed cheerleaders, I will welcome the chance to do LPs in the future!  I know that kids are a hard audience (gee, a stranger is coming at me with a big needle and going to put that WHERE!?)...but the more chances I'm getting to do procedures, the more and more I'm loving my job.

So bring on the procedures...just leave your cheerleading bloomers at home. Because this PICU APN wants nothing to do with that!

Assertive APN

Yup- it was as bad as I thought!

Parts of it were actually worse.

At one point I found myself squatting in an alcove in the back of a secluded hallway thinking "What in the world am I doing here!?"

If you haven't read my last blog post, you have no idea what I'm talking about.  And the above sentence may just sound downright creepy!

So to fill you in- I'm talking about taking the PICU APN out of the PICU and plopping her into the great abyss known as the OR.

The OR could not be any different than the PICU.

And it certainly isn't for me!

I went there for airway management skills, and left with more frustration than knowledge.

We have 3 floors of ORs...3 FLOORS! And each floor has about 20 ORs.  So that's a whole lotta OR rooms that I have to troll myself into and try and convince the anesthesiologists to teach me airway skills!

Oh it was lovely fun.  Creeping outside each OR room, waiting for someone to show up.  And then it was the same speech- "I'm an APN from the PICU and I'm here to learn airway management."

This speech got me tons of different comments ranging from:

"I'm an anesthesia resident, and you cannot take procedures from me...I need this experience"

"Umm, this room is already a bit crowded...maybe you can find another OR" (stated by an anesthesiologist in a room with 5 other people...very standard for the LARGE ORs!)

I got a TON of "I already have a resident with me...go find another room without one."

And then there was the "Oh, I would LOVE to teach you, but I just don't have any interesting cases today.  Are you here next week?"

Gee, thanks guys!

I will say the most helpful and amazing 4 people I met all week were as follows:  3 were CRNAs (or APNs that are anesthesiologists), and an anesthesiologist that also worked in the PICU with me for the last 8 years!

Gotta love that the APNs stick together!  One even said, "I can't believe you have to go room to room, hoping someone will take you in...it can be brutal among anesthesiologists!"  Umm, definitely agreed!

So I'm done with the OR!  I want to learn airway management...its crucial in the PICU...but I don't want to do it this way!

I told our scheduler that the best way to get these skills would be to pair up with one of the CRNAs who will gladly take us under their wing, teach us, and give us the hands on experience that we need! And 2 of the CRNAs that I met said they would be more than happy to be the contact person!

So while this brilliant idea may not apply to me, at least it will help out our new hires from now on!

Its funny that all the APNs before me went through this, and have nothing positive to say about it.  And all of our attendings in the PICU have had to do this in the past year to keep up their airway management skills. And of ALL the attendings that went through, ALL of them have said "Ugh, that was the worst week ever!  I could barely get my hands on a patient!"

If anesthesiologists aren't letting PICU attendings intubate the kids, there is NO way they will be letting brand new APNs!

So this APN isn't going to be another one of the above...another APN that goes through, hating the experience and then letting others after them have to endure the same thing!

It is my newfound PICU mission to help the APNs that we have starting in January...and all the ones after that get their airway skills without wanting to gouge their eyes out!

You can now call me Assertive APN.  I may be new, but I get things done.

All in the name of the PICU.  Booyah!

Back in the OR

And here we are- another Sunday...another lonely blog post!

Grr...I so love blogging.  And yet I just don't do it much anymore! I don't know how people keep up with blogging several times a week, or every day.

What I will say, is despite me not blogging about it much, I do love it.  Being a PICU APN that is. And really, I think that's much more important.

So, moving on.

I barely got through my week of nights.  I got through.

There was a point at around 4 or 5 am on my last night where a nurse was asking me a question.  I could see that she was moving her lips, and heard words coming from her mouth, but really could not piece what she was saying together (sounds real safe, huh!?).  Well to my defense, once I snapped myself out of it, I made some really good judgement calls!

And funny, I told her "I am so sorry, I'm only like 50% right now. I promise in 30 seconds (after I do a weird jiggling and jumping sort of wake me up dance) I will be back to 100...ok, maybe 95%- but that should be good enough!"

After laughing at my ridiculous wake-me-up-now dance, she then replied, "You look WAY better than 50%. Some people around here are drooling and all baggy-eyed...but you still look fresh!"

I just laughed.  I saw myself about an hour before. If that is her definition of "fresh" for me, I am a sad case!

So I caught up a lot on sleep this weekend.  And spent some good, lazy quality time with my man.

And this week I'm back in the OR.  Oh, how I DO NOT want to go there.

I actually tried negotiating with our scheduler to see if there was a way to put it off until January, or February. Or never!

I know that its great experience. And experience that I definitely need. I just think going into someone else's home, a home that I've invited myself into by asking the nanny and not the homeowner, and then showing up saying "I need you to teach me!" is not the best approach.

I wish there were ample opportunities daily to intubate kids in the PICU. But that just doesn't happen (good for them, bad for me trying to learn).  And with the first year fellows also needing the opportunity, those chances dwindle exponentially.

So, I'll go into anesthesia's home this week.  I will try my best to be a great house guest.  And hopefully I will come out of it with a great experience and a bunch of successful intubations under my belt.

But if not, I will gladly run home, back to the PICU, where I know my family will be waiting with open arms. Especially because we are short staffed right now.  But, also because they love me!  Ahh, there's no place like home.

Back to Nights

Apparently my first call shift took a lot out of me, because I haven't blogged since that day!

I actually can't complain because it was a relatively quiet night and everything went well.  I even got to lay down for several hours.  And even though I never fully fell asleep, just being able to slightly "turn off" was nice.

I'm back to nights for this week.  I'm hoping that they go as well as the first one went.

One of the nights I work is Halloween though, so I'm not very optimistic...crazy things happen!

If anything, I'm hoping to see a few cute kiddos in their costumes.

Oh, and in my "spare time" I'm working on a post to answer some of the questions that I've gotten via comments and e-mail lately regarding my job, responsibilities, differences between bedside nursing and being an APN, etc.  Please don't think I'm ignoring you!

I promise, as soon as I shake off working nights and can think clearly, I'll be all over it!

Nights and I aren't friends.  I would love to be, but we just aren't.  I just calculated today that I am responsible for doing 39 call shifts (16 hour nights) each year.  So basically after this week I'll be 4 down, 35 more to go.

Oh well.  At least I love my job!

First Call Shift

I won't bore you with another pumpkin baked good post today.  Although, I am going to try a new pumpkin cookie recipe today...thank you pinterest for making me fat!

Instead, I will keep this short and sweet. And even about the PICU.

I am taking my first call shift (AKA: night shift) tonight on my own.  No more preceptor.  Just me, the big PICU, and a whole lotta sick kids with a whole lot less staff present.

But I'm actually really excited about it.

Yes, I'd much rather spend my Friday night on a date with my hubby, but if I had to work (and I obviously do!), I'm glad to be in the PICU.

So with excitement, nerves and a little bit of anxiousness, I need to find a way to chill out the rest of the afternoon, and hopefully take a little nap.

Hope you have a great Friday.  And if you're working the night shift tonight, give me a holla at 3 am...it may be what I need to stay awake : )

Pumpkin Chocolate Chip Brownies

I promise I didn't quit my APN job and become America's next great Food Star...although that would be AWESOME!!!

It's just that nothing crazy, super exciting, hilarious or really blog-worthy has gone on at work lately.

I will say, each shift that goes by I am becoming more and more confident.  I am feeling like I'm getting the hang of things, and while I have a long (long!) way to go, I will get there!

Probably the biggest adjustment has been figuring out how to keep the relationship with patients and families that I so loved being a bedside nurse.  It's definitely very different being an APN because I am running around the insanely large unit all day, and so my time with each patient and family is much less than when I spent the entire 12 hour shift at one bedside.

But I'm sure as time goes by, I'll figure that out as well!

Until then, I'm going to bake my way through pumpkin recipes on each of my Fall days off!

My pants buttons may not thank me come winter time (isn't that what stretch pants are for!?), but my palate certainly will!

Here is probably the most simple, quick dessert that can be thrown together for any party (or Monday afternoon!) and be a hit.

I didn't even have time to take pictures along the way, because from beginning to oven it took maybe 3 minutes. And then Jonny and I gobbled a good portion of them up....sad, I know.

Directions:
1.) Empty one box of brownie mix into a bowl (yes, my mom's homemade brownie recipe would be much better, but this is the speedy version)
2.) Add 2 whole eggs, and 1/2 to 3/4 can pumpkin puree (unsweetened)
3.) Add a few dashes of pumpkin pie spice to taste (and really, batter tasting is the best part!)
4.) Add a handful (or so) of chocolate chips...because really, more chocolate makes everything better!
5.) Place in baking dish, put in oven for 35 minutes, and savor the smells that will waft through your house

It's that easy!  And that delicious!  Yup, just one more pumpkin recipe that nailed it...add that to my recipe book!

Pumpkin Chocolate Chip Cookie Bars

It's been awhile since I've posted anything yummy that Jon and I have made.

Come to think of it, it's been awhile since we've really made anything all that yummy.  I mean, we make dinner together several times a week, but since we've been so busy lately it's been the same old thing most nights.

Until today.  I've felt extremely productive today.  I woke up at 6 am all on my own...thank you PICU for waking me up so early so often, because now I'm just used to it.  And sleeping til 6 felt like I had slept in!

So I got out of bed, and really got a ton of stuff done.

Including looking on pinterest for an inappropriate amount of time.  But I was on a mad hunt to find something that would satisfy my pumpkin and sweets craving without going straight to my hips...or other places weight seems to be creeping on!

And then I found THIS... and while it looked good, it didn't have pumpkin.  So, I made it my own!

And I think it's awesome!

Plus, it was super easy to make, and I didn't have to go to the store for anything...always a bonus!

Oh, and I didn't mention that there is not one bit of flour or refined white sugar...the base of the cookie is chickpeas!

Yes, I said chickpeas...but I promise it is good...and you won't even be able to tell!  So give this recipe a try, and let me know what you think!

Ingredients:
-1 can chickpeas
-1/4 cup + generous spoonful natural PB
-slightly less than 1/2 cup canned unsweetened pumpkin (not pumpkin pie filling)
-1/4 cup agave (or honey, or whatever sweetener you choose)
-1 tsp baking powder
-2 tsp vanilla
-pinch of salt
-dash of allspice
-generous dash (or 2) of pumpkin pie spice
-1/2 cup chocolate chips (I used milk chocolate because that's what i had, but semi-sweet would be good too!)

Directions:
1.) Preheat oven to 350 degrees
2.) Combine all ingredients except the chocolate chips in a food processer.  As you can see, I tried using a hand mixer because my food processor is small, and not all that....hint hint *upcoming birthday* : )  But, the hand mixer doesn't make the chickpeas smooth so you definitely do need a food processor!

3.) Once everything is mixed, spread in a baking dish. The original recipe rolls into cookie dough balls, but this was too moist with the pumpkin...so bars it is!

4.) Place in oven for about 40-45 minutes.  I tested this every 10 minutes or so until a toothpick came out clean.

5.) And enjoy...the best part!  As you can see we almost polished off the entire pan!

Hope you have a *sweet* weekend!

Wanted

Wanted:  PICU APN

                            Description: 5'2'', blonde hair, blue eyes

                                                                Last seen: Running around the crazy labyrinth also known as the                                                

                                                         PICU, then on to Rochester, MN for a few day Critical Care conference

                                                  Most likely to be:  completely hiding out at home, in bed

Oh yes...the last few weeks have certainly been crazy.

Just when I thought the PICU was going to have a bit of a lull, it completely picked back up and caught us by surprise.

We not only had a ton of kids come in, but we had a ton of sick kids!

And then on top of putting in a bunch of hours, I thought it would be a great idea to go to the exciting city of Rochester, MN (sorry for any of you living there!) for a Critical Care conference.

While the conference was a great learning experience, it was very different than what I expected.  Namely, I thought since it was an SCCM (Society of Critical Care Medicine) conference, it would have tons of people there.

But "tons" translated into exactly 16.  Yes, a very large, very full 16 new APNs, PAs, residents and fellows.

I will probably write a post about this soon, because it was a great learning experience, but I'm gonna end the post here...I'm not ready to be "found" just yet!

So I'm going back to my comfy bed, in my comfy pants, and watching some football with the windows open to let in the crisp fall breeze and the warm sunshine in, until I must be "Found" tomorrow at work.

Flying Solo

Well, I did it...

I made it through the first two days on my own as a PICU APN!

My preceptors thought I was ready to fly solo, so after being away from the PICU for 3 weeks, I came Thursday and yesterday not as an orientee, but as a full-fledged PICU APN.

I think I've said multiple times now that I'm an "official APN" like when I passed boards and became certified...when I was hired...when I started, etc.

But really, NOW I feel like it's official!

And last night after my second shift was done, Jon asked how it all went.

My response was "Well, I didn't kill anyone, so it was a great 2 days!"

To which he responded "Baaaabe, don't say that! That's horrible!"

I just laughed.  Because really, if you're in healthcare this is something that is said ALL the time.

Case in point: Yesterday a co-worker was asking how my first day on my own was and I simply said "good".  She laughed and said, "Yeah, well no one died yesterday, so it must have been good!"

See, it's just not me who's into the whole morbid PICU humor!

I must say I lucked out for my first 2 shifts. When I left the PICU 3 weeks ago, we were maxed out with patients at 14 (when we usually only take 12 because there are only 2 providers on each day), and on top of having a lot of patients, many of them were really sick!

But this week, things have slowed down a bit.  Our team had 9 patients, and not too many were extremely sick.  So that helped me out a lot!

And I'm hoping that the" slowness" carries on through the weekend because I'll be spending 24 lovely hours there this weekend.  And actually I'm insisting on slowness because tomorrow I will be the only APN working with one fellow, and Sunday I am the only APN with NO fellow!

Hello! That doesn't seem ideal!

But it's where I'm at.  So here's to hoping that flying solo throughout this weekend will result in soaring, and not crashing into windows!

                 source                                                                                                          source

So fresh and so clean, clean

Got that song stuck in your head now, don't ya!?

This post actually has nothing to do with the PICU. It has nothing to do with anything APN related either!

But every once and awhile, this PICU APN needs a break!  *No, I'm not forgetting the fact that we just got back from vacation about a week ago!*

And I'd say that's where today's post comes in.

Today's thoughts are about something deep.  Something you may need time to ponder.

It's about deodorant.

Yes, you heard that right...deodorant!

I don't have a deodorant brand preference.  I usually just buy what's on sale, or what's "free" with my CVS extra bucks.

But I noticed the other day when I was putting a few brands away after a little deodorant shopping spree (oh, no one else does that!?) that the labels are a little ridiculous!

For instance, why in the world would anyone need 48 or 72 hour protection!??!??!?

Are people really only putting deodorant on every other day?

I would think that a good 24 hours...or even 18 hours would do the trick!  If you can provide adequate smellage (yes, that's a word!) coverage while I'm working long shifts, than that's a winner in my book.

But does buying a deodorant that provides 72 hours of coverage really make it that much better?? I'm not sure.  I guess I've never paid attention.

So next few weeks when I'm working 10, 12 and 16 hour shifts, I guess I'll find out!

Until then, I'm going to let you ponder it over.  Deep, I know!  That's about as good as it gets on a Tuesday folks!

What Success Feels Like

In my last post (here), I talked about how incredible successfully intubating a patient was.  Except that I was only basing that on things that people told me.  I had actually never done it before.

And to be quite honest, it was the one thing, the one procedure, that was expected of me in the PICU that scared me.  A lot.  Or maybe downright terrified me!  

Either way, I hadn't done it, and  had never really been taught(at least on a human...mannequins don't count!).  And so part of the terror may be the unknown.  That, and the fact that it may be the one life saving measure for kids in the PICU that I had NO clue how to do!

Until today!  

That's right.  I successfully put in an ETT all by myself.  I'm a grown up APN now : )

I had an 18 month old patient that we were just expecting to put an LMA in.  But then the surgeon changed his mind at the last minute on how he wanted him to be positioned on the table, and we decided (ok, really the anesthesiologist decided because I don't know what the best airway in the OR based on positioning is!) to intubate.

I didn't even have time to think about it or get nervous.  Which was actually probably the best thing possible.

The attending anesthesiologist and the resident were hovering over each of my shoulders.  Normally this would make me start sweating profusely, but I actually was relieved that they were able to see exactly what I was seeing.

No more episodes like the other day when I'm saying the airway is super small, and the attending is saying "Uh, yeah kids airways are small!" without actually seeing what I'm seeing!

I must say, I stayed cool, calm and collected...MUCH more so than I would have been had I had to "prepare" for it prior to the case starting.

And I just slid that ETT in easily.  I saw the cords, and saw the ETT glide right through them.

It was such an incredible feeling.  Exciting. Exhilarating. Nerve-racking. Proud. Amazing!  

I did it! 

I conquered probably what was my biggest fear in the PICU.  And on an 18 month old, with a "very small airway!" 

So I learned a few important lessons today on success:

1.) Success is so much better after an initial failure

2.) Success is so much sweeter when it is a success at conquering a fear

3.)  Success is so much more special when it can be shared with others...who can praise you and gush over how well you did!

OK so the last one is a little bit of a joke, but let me tell ya it made my success so much better hearing the compliments and praise from both the attending and senior resident anesthesiologist!  The attending even said, "Wow that was great technique! Much better than many first year residents who have done this a bunch of times already!"

Bo-Yah!  

So there are my thoughts on success...and my success story!  I know down the road I may read this post and think," Wow, I've intubated a good 1000 times now, and could do it with my eyes closed...that's so cute that it was such a huge success back then!"

But until I get to that point, I'm going to savor the success after a failure, the success of conquering a fear, and I will most definitely savor the praise and gushing over that success!

APN in the OR!

Yes, I've been MIA.

But I've had a good excuse.  I'll give you one guess...

Yup, you probably guessed right! Jon and I went on vacation!

Well, it was a combo vacation and work conference for Jon, but it was full on vacation for me.

It was great!  It was 11 days full of nothing PICU related, no stress of trying to keep a little kid alive, and not overwhelming my brain with ridiculous amounts of new medical information.

But now I'm back to the real work.  Except, not my true real world.  I'm in the OR all week working with anesthesia.

That's right, an entire week of bag/masking, putting in LMAs, and intubating.

Let me tell you...there was about a half second that I thought about going to school to be a CRNA as opposed to an acute care nurse practitioner, and I'm SOOO glad that thought dissipated after the half second.

While successfully intubating a patient is an incredible feeling (or so I'm told because I haven't done it yet...I'll get to that!), doing that and giving gas/anesthesia to sleeping kids with very little interaction with the patient or family is SO not up my alley.

I love the PICU because I get to know my patients so well.  I get to form relationships with them and their families.  And that is so rewarding.

Nobody really leaves the hospital and profusely thanks their anesthesiologist...but they certainly leave thanking their PICU nurses and nurse practitioners.  That is not to say that their job isn't important (it's crucial to staying alive and asleep during surgical procedures!) but it's just very different.

So now that I've re-established my love for the PICU, let's get back to the successful intubation scenario.

I've spent the last 2 days in a satellite hospital OR which is super tiny.  There are 3 OR rooms- only 2 were being used yesterday, 1 today.  That means there are few cases each day.

And it means that it is all outpatient cases which tend to be "quick and easy."  So most kids don't get intubated.  A majority of mine yesterday got general anesthesia and just required a little bit of bag-masking, or even a nasal cannula.

I was able to place about 5 LMAs though which was good experience, and makes me feel more comfortable when I'm on nights in the PICU and more alone...if a patient is a difficult intubation I know that I can place an LMA!

So there was one patient today that could have had the procedure done with an LMA, but the anesthesiologist decided to fully intubate her for two reasons: 1.) so that I could have the practice, and 2.) because there is a propofol shortage and that's the medicine that he would have used if she wasn't being intubated.

So I got the chance to try to intubate her.  I had good technique with laryngoscopy and was able to visualize the vocal cords, but was unable to pass the tube.  The anesthesiologist asked if the vocal cords were open, and while I had a great view, I told him yes, but it looked really small.

He told me that the airway is small, so it wasn't going to be big, and try again. *Thanks, I know kids airways are small*

So I did try again, and once again could not pass the tube.

The anesthesiologist decided to attempt, and he said- "Ohhh...that's why...she's not fully muscle relaxed so her vocal cords are too compressed."  YUP- that's what I said...her opening was very small! So he muscle relaxed her, her vocal cords widened, and he easily passed the tube.

So I was frustrated at myself for not being able to get it...and then felt a whole lot better that there was an anatomical reason for why I was unsuccessful.  I was also really glad to have this experience in the OR, where it is an extremely controlled setting, there are no parents freaking out, and it is super quiet!

I have 2 more days in the OR this week, and I'm hoping to get a few more intubation opportunities tomorrow.  With only about 7 cases that may be unlikely, but we'll see.

So until this weekend, you can call me pseudo-OR-APN!  But I'll always be a PICU APN at heart!

An APN Victory in an Initial Failure

One of the things our PICU is working on is figuring out how to get a full service APN team that collaborates with a fellow on service each week.

This equates to Nurse Practitioners being responsible for knowing how to do procedures (art sticks, line placement, intubation, chest tube insertion and removal, lumbar punctures, etc.), but not necessarily getting the opportunity to fully learn how to do so.

Every July through oh, about the end of the year, this is especially a problem.  Every July we get a new bunch of fellows.  And this equates to a new group of fellows who also are responsible for knowing how to do above procedures.

So there's this internal, not quite discussed conflict over procedures.  Except now it's being discussed a bit more.  APNs cover 100% of the night shifts, in conjunction with a fellow, and an attending.  Except 50% of the time, the fellow is covering the new Cardiac ICU and are no longer in the PICU.  So that means an APN is working solely with the attending...most of whom truly value their sleep!

So in this struggle over procedures, let's just say my orientation has not been all that enriching in this area.  Several of my patients have been intubated, several have had arterial or central lines placed, and yet all of them were done by the fellow on service.

And I must say, I wasn't all that disappointed at the time.  But now, as I'm almost done with orientation, and know that I will be held responsible for these things, I wish I had the opportunity.

So this week, when I heard a new patient needed an art stick for some labs, I was all over it.  It wasn't my patient, but I at least wanted the opportunity to try.  And while in some hospitals this is something that the bedside nurses or respiratory therapists do, at my hospital, only the APN or fellow does this.

So I got the opportunity to do my first every art stick!  And while I didn't get enough for a sample, I got a flash, and at least the feel for it.

In my defense, the patient was a 2 year old who ingested multiple medications from his father's medicine cabinet, and was neurologically intact.  In fact, he was kicking, screaming, and trying to hit me as hard as he could with the arm I was trying to get blood from.

So not getting this one on the first try wasn't too big of a blow to me.  I know that I hit the artery, and in response the child hit me, so I lost it (thank you fellow who wasn't holding him down properly!).  But I am grateful for the opportunity...even for something so small!

I think this is the APN equivalent of taking my first manual blood pressure or doing my first accucheck as a nurse.  And while I'm sure I will look back on this many years to come and think, "Oh newbie APN, an art stick is now something you could do with your eyes closed and one arm tied behind your back," it is something that I will mark down as a first for now.

So here's to a celebration of firsts.  And while after 101 of them, it may seem trivial, it is so important to celebrate the small victories.  Because PICU APNs...or APNs in general...know that it is the small things that get you through some days.

For all you experienced APNs, what was one of your first small victories??? And all you in nursing school, what are some victories you have had, or are looking forward to!?  Nothing is too small here...and this is coming from the APN who is taking a victory in an initial failure!

Running with Infectious Diseases

OK, I think the title is a bit misleading.  I sat for a few minutes and couldn't come up with anything clever so I decided on the above.  Then I re-read it and decided it is quite disappointing, but that's all ya get folks.  My creative juices have been apparently zapped this evening.

The title is misleading because I don't have an infectious disease (thank goodness!).  And if I did, I certainly wouldn't be running!

But, what did happen was that I spent the week out of the PICU, and in with the Infectious Disease service. And, as I'll get to a bit later, this led me to having some great workouts!

I must say Infectious Disease this week was a great change of pace.  Scratch that- an amazing change of pace!

Never once did I hear the word "stat" used.  Decisions were made, but not every with a huge sense of urgency behind any of them.  And certainly while antibiotic/antifungal/antiretroviral treatments are extremely important, and life saving at times, it just can't compare to the day to day in the PICU.

That being said, I learned a ton. One of my [many] weaknesses is antibiotics...and I guess Infectious Diseases in general.  Rashes creep me out, if that's any indication!  So this was a great experience for me.

And who wouldn't like to be a part of a service that started at 9 am and got to leave between 4 and 5 pm!?!?  OK, well at least I did.  The fellow is pretty much on call 24/7.  But I got a sweet end of the deal!

Oh, and I greatly took advantage of the extra time in the morning...I was able to run 4 times this week! I'm pretty sure that hasn't happened since before I started grad school!  Holla!

Who wouldn't love running with this amazing view!

 *Even on an overcast day, the sunrise was still trying to peek through!*

*Gorgeous, bright and sunny morning!*

So here's to a great week of awesome workouts and a great Infectious Disease service week.  That's a success in this PICU APN book!

And to top it all off, I have a 3 day weekend filled with some bachelorette party and wedding fun!  Hope you have a great weekend in store as well!

Start of a new week & a sigh of relief

So at the end of last week I had a bit of an internal freak out moment!  I thought it was my last day being precepted in the PICU.

My preceptor who has been my primary since the beginning said she was going to "let me fly solo" and she definitely did.  I felt great at the end of the night, knowing that I provided great care for my patients.  But despite that, I loved knowing that I had the safety net of a preceptor the entire shift.

I will be spending this next week with the Infectious Disease team and I'm so excited! My sister laughs at me when I say this (I think she thinks Infection = Gross!), but I truly am looking forward to learning about "bugs and drugs."  This is one of the cornerstones of the ICU and something that doesn't get taught appropriately in undergrad or graduate nursing school.

So back to my freak out.  The husband and I are taking a vacation/work conference for him at the end of the month.  This meant that I would have a week in the PICU, a week with ID, and then a week off.

Or so I thought!

I treated last week as my last one being precepted, and it was great being independent.

And then I realized there was actually another week in the month! Hello...way to calculate properly!  So I get a bonus week of being precepted and I'm excited about it.  I'm hoping that it will be an entire week of letting me "fly solo" just to prove that I can do it.

And then I can let my safety net go.

Except that's the wonderful thing about the PICU.  There are always safety nets.  That's what the fellow on our service is for.  And the Attending overseeing the both of us.  And the specialty services that we consult.

So despite shaking off my preceptor safety net, I have plenty of others to rely on.  And this is a safety net of its own.

So I will truly enjoy my week off the PICU this week, spending time with Infectious Disease.  It will be nice to have a week of a little less stress...ok, a lot less stress.  And a week of actually getting out on time ( or so I hear).

So here I come Infectious Disease....bring on all the grossness, the bugs, and the drugs!

12 Hour Shifts

We started trialing 12 hour shifts this week with our APN team.  There are some definite kinks we need to work out, and some definite adjustments I need to do.

It wasn't that long ag, that 12 hour shifts were all I knew.  For my entire nursing career!  And yet after a short 3 months, I had forgotten just how LONG they are!

I'm realizing though, that in scheduling and 12 hour days (and pretty much every other facet out there), being an APN is SO different than being a nurse.

Bedside nursing 12 hour days meant being stationed in one or two patient rooms the entire day. Don't get me wrong, there were plenty of shifts that went by that I had not gotten to sit down, or eat, or pee.  But for the most part you were stationary in a small space.

APN 12 hour  days means a whole lotta walking!  Especially in our new hospital where there seems to be about 4 miles between the patient in bed 1 and the patient in bed 41.

Bedside nursing 12 hour days means that at 7 pm your relief gets there, and you tell them about your 1 or 2 patients. Most times this takes no more than 30 minutes. Out of there by 7:30 and on your way to enjoying a day off most working people don't get to enjoy.

APN 12 hour days means that at 7 pm your relief gets there, and you have to tell them about your 14 patients (this is one of the kinks we're working out...from 4 pm until 7 pm there is only 1 nurse practitioner covering the entire team). This certainly takes more than 30 minutes.

And if you have to get an admission, or 2 like I did on Wednesday, right in that 7 o'clock hour, well you can just kiss getting out of there at a decent time goodbye!

I left after 9 pm on Wednesday, and let me tell ya the prospect of driving a little over an hour home, then having to eat dinner, shower, get lunch and everything ready for the next day to do it all over again was nauseating!

So I'm not really sure how I feel about this whole 12 hour APN day thing.  It's only been one week, and it may grow on me.  I may enjoy the extra day off each week and not even care how late I get out.

So far, half of the APNs love them, half hate them.  And half of me loves it, and half hates it...so we'll have to just wait and see!

What I DO know, is that all of me is glad to have this weekend off completely!  After 3 12 hour shifts in a row, most of which turn into 14+ hour shifts, I will cherish every moment of this weekend!  I hope you do too!

APN Bootcamp

So this week we had APN Bootcamp.  Time to whip my PICU booty into shape!

Sounds kinda intimidating, huh!?

I was actually kinda nervous going into it, mainly because a majority of the time we were in the simulation lab where all kinds of scary can happen!

But it wasn't so bad.

And it was even kinda fun!

I successfully intubated a baby for the first time (first time to try, not first time successful)!  A SIMBaby that is...as in one that doesn't really breath, or have a real heartbeat, but hey, I'll take what I can get right now!

We also got through a full code in one of the PICU rooms, and didn't kill our dummy, so that's always a bonus : )

There were lots of lectures about communication and how to really speak up to give our patients the best possible care.

And of course there are plenty of scenarios using SimLady and SimBaby that can talk by the man or woman behind the window.  There's nothing like talking to a plastic patient, and having them actually talk back!

So time to enjoy a fun weekend with the family after an exhausting week of bootcamp!  Hope you all have a relaxing, fun weekend without work!

Back to Nights...and other ramblings

Today's post will be a quick one because I am back to working nights this week.  I'm still trying to figure out what routine will work best for me on the first night that I work.

Do I wake up early and have a better chance at taking a nap? Or do I sleep in and just assume I'd probably not get a nap in anyways!?

Do I just chill until I leave at 2, or should I be more active in the morning, get a little sleepy and then lay down for a bit?

I don't think there's a right answer for now, so I'll just do whatever comes to mind today.  Unfortunately that started with an early morning dentist appointment that still has the entire right side of my mouth and cheek completely numb!

Hopefully that wears off before I start my shift...patients don't want an APN looking like she's having a stroke because one side of my face doesn't move when I talk, laugh or smile!

But I leave you with something funny.  Every time I drive home from work, I pass this cemetery by, and without fail, makes me laugh!

I wish I had a better zoom on my camera phone...I'm not sure if you can see what the sign says.

Sign on cemetery fence: "Come Worship with Us!"  And then it proceeds to list times for worship, Sunday School and Adult Bible class.

There must be a church hiding somewhere back there, but it is certainly not visible from the road!  Until then, I keep laughing that those in the cemetery are inviting us to their weekly worship!  Creepy!

Here's to hoping that tonight's shift won't be equally as creepy!  And for those of you that are night shift pros, I'd love to hear your tips!

The Day I felt like a Dummy

Ever have those days...those weeks that you just feel like a dummy!?

Yeah, that would be me today!

It's July which in hospital speak means all new fellows and a new class of residents.  In RN speak that always meant "Argghhhhh!!!!!"

I haven't decided what that means in APN speak just yet...but I'm sure I will.

Anyways, along with the new PICU fellows every year comes lectures on things we should know to be successful medical professionals.

So today's lecture was: "Basic Principles and Pathophysiology of the Respiratory System"...sounds riveting doesn't it?

Unfortunately, the majority of what I understood was the words in the title.

I am pretty sure that for part of the lecture, ancient Hebrew or some little known dialect of Korean was spoken.  There were all these equations and big medical words that I had never heard of before.

So I have a lot...a LOT...of learning to do.

But what was funny was that one of my preceptors who has been in the PICU for about 10 years leaned over and said "Does that make sense?" to which I simultaneously thought "Not a chance" but said "Uh-huh!"

Nice.

Of course, right in the middle of the lecture is not probably the best time to say, "Nope, don't really understand 75% of what is coming out of her mouth...can you translate it in simple new APN terms for me?"

So "Uh-huh" it was!

At the end of the day, it all goes back to being a new APN means a whole lot of learning to do.  And sometimes that means feeling like a real dummy.

Guess I'll start with my version of "Basic" and go from there, which I'm pretty sure is miles away from the "basic" being taught today! But ya gotta start somewhere!

When a headache is just a headache

I took care of a patient this week who was 13 and came in with altered mental status that started with a headache while playing basketball, and was severely hyponatremic (very low sodium levels).

I took care of him a few days after he was admitted, and other than being weaned off his 3% sodium drip, he was back to baseline.

Until he got a headache again in the afternoon.  The bedside nurse paged me and told me that mom was very adamant that I come immediately.

I went to examine him, and the nurse was right: the mother was just shy of freaking out.  And I guess I can't blame her...it was a headache that started his whole initial downward spiral that led him to going unconscious and getting intubated for a day.  She was telling me "The doctor at the other hospital ER told me that with him, a headache will never just be a headache" to which I had to think, why do people say these things sometimes!?

I get that in that circumstance, the headache was an initial indicator of other serious underlying issues, but sometimes a headache is just that...a headache!

And to prove my point, the patient kept rolling his eyes the more his mom was talking.  When I asked how bad his head hurt, he said 3/10.  And then he proceeded to tell me that his head only started hurting after he was wrestling with his 8 year old brother, his 3 year old sister was running around the room screaming for 15 minutes, and his 9 month old brother "made the biggest stinky ever"..."That would make anyone's head hurt!"

I completed his exam and told the mom that it was completely reassuring.  I told her all the things that made me not concerned with this headache, and things that I thought would help alleviate it completely, including some tylenol, no more wrestling, quieting the screaming toddler, and yes, that diaper STUNK...get it out of the room! Not that a stinky diaper alone would make a head hurt necessarily, but no reason to keep something so vile in a sick patient's room!


Before I left, I asked the patient if he had any more questions.  His answer:  "Yeah...can you please tell my mom to stop freaking out!? I told her it was just a little headache, and if my brothers and sisters would just leave, it would go away.  But she went crazy and had you running over!"


To which I answered, nope, I can't do that...it's a Mama's job to be worried like that.  


And it's my job, as the APN, to help the worried Mama understand that in this circumstance, his headache was just a headache.


I left the room with a much more calm, reassured mother.  Job well done to the both of us!  

Co-workers will make you or break you...

and my co-workers are making me!!!  Making me into a pretty decent PICU nurse practitioner!

I must say this has been a crazy transition from nurse to nurse practitioner.  But I have thoroughly enjoyed it largely because of the great people that I work with!

Several times this week I have gotten compliments from physicians or other APNs at how well I'm doing.  A few came after some rather rough conversations in which I felt like a dummy...so maybe they were just trying to build me up.

But what great co-workers! Instead of making me feel like an even bigger dummy, they compliment me!

And yesterday I presented one of our really sick patients and the liver/GI team was there.  The liver team is notorious for interrupting PICU rounds and making it a bit painful for the person presenting.  After a couple of interruptions, the PICU fellow spoke up for me.  She said "Dana has all the information, and she's presenting it in a clear, logical manner.  Let her get through the presentation, and if at the end some of your questions or concerns are not address, we can discuss it then."

There were not any interruptions after that.  And yes, I probably should have spoken up for myself, but it was nice to not even have to.

That's how great my co-workers are!  I am one lucky PICU APN!

Fancy Fruit and Fireworks

Happy 4th of July!

To all my nursing friends that had to work today, I hope that you didn't have to work too hard.

I on the other hand, did not work today...at all!  It was truly a relaxing a fun day with my hubby.

We slept in, had coffee leisurely in bed, and then headed out into the heat for some soccer.  Which really just turned into passing the ball around because it was just TOO hot to be running!

Then we came home for some awesome grilled black bean burgers and beers.  And then I inflated my little 2 man boat and filled it with water, to make my very own personal plunge pool.  It was fantastic, to enjoy the sun and outdoors, but stay cool at the same time!

And then we relaxed some more.  Tonight, it's movie time.  But not before we grilled yet again (this time chicken and red peppers) and a nice tossed salad.

AND grilled peaches.  Oh MY!  These were GOOD!!  I've seen a few magazine articles lately about grilling fruit, so I thought we'd give it a try.  And this is a winner!

Plus, it was super simple.  I looked up a few recipes and just took bits and pieces of the ones I found to make what I thought sounded the best...and these did not disappoint!
 
1.) Cut the peach in half, and take out the pit.
2.) Melt a little bit of butter and add cinnamon and a dash of rum.
3.) Coat both sides of the peach with the butter mixture.
4.) Grill on each side for 4 minutes.

We ate these plain, but they would be absolutely AMAZING with a scoop of vanilla ice cream, or even some homemade whipped cream! YUM! 

 And what's some good grillin' without a handsome grill master!?

So it has truly been a happy, if not super relaxing, 4th of July!  And really, with all the stress and craziness of the PICU, what APN could ask for more!?

Seizures, Stories, and Sleepiness!

If ever there was a potential for disaster, the title about sums it up!  First off, sleepiness for me is almost a recipe for disaster.  And then when you throw into the mix a patient seizing and several different stories from several different nurses, it makes for quite the interesting interaction.


The Background:
I just layed down to try and get a little sleep around 3 am.  The previous 11 hours of the shift had been really busy with 2 admissions and just a bunch of miscellaneous going on.  So I was grateful to get to try and rest, even for an hour or so.

Except that my brain wouldn't shut off.  And I could feel my eyes moving back and forth really fast every time I closed them.  Ever have that...or is that just weird!?

Anyways, about 40 minutes later, just as I was starting to doze, I get a page saying "She's seizing."

Umm, ok, first off...WHO is seizing!?  Second, what is going on??

So it was a girl with a known seizure disorder who came in with a viral URI and increased seizure activity.  OK- no problem.  I talked with the Neuro Critical Care team about an hour before, and had a well devised seizure plan.

The Plan:
Before walking over to the patient room, I wanted to wake up my preceptor (who by the way is just so smart and has done this PICU APN thing for so long that her brain can shut off in 2.2 seconds...so she was out!)... I wanted to wake her up to go over my plan of action with her.

It was simple...go and evaluate the patient, make sure she is truly seizing, give 0.05 mg/kg ativan because we have it on the unit, and then order 20 mg/kg Fosphenytoin.

My preceptor loved the plan, asked if she wanted me to come, and I said no since the patient was fine.

This all happened over the course of about a minute.

The Action:
As I am walking through the labyrinth that apparently is called the hallway, I get a call from the nurse saying "She's desatting...are you coming soon!?"

To which I answered...Yup, right outside the door!

The Scene:
I walk into craziness...or my perception of it anyways.  The patient is definitely seizing.  And she is definitely satting 67%.  There is a nurse I have never seen before attempting to bag mask the child, but is obviously not effective at that moment.

Then you have the mom who is frantically pacing in the room and kept shouting "Is it OK that her sats are this low....how long can her sats be in the 60's...is she going to be ok....is it OK that her sats are STILL this low!?"

And then you have the bedside nurse that paged me who is giving me the story in about 8 different increments, and not in chronological order as I would have appreciated : )

And then you have another nurse saying over and over "Do you want me to give ativan again....do you want me to give ativan again?"

It was a mild form of chaos in that room.  And probably much less chaotic in reality than in my head, but being in the role of responsibility puts a whole other level of stress into the situation.

What I Wanted to Say:  SHUT UP!!! Seriously, everyone shut up!  Mom, I promise to answer your questions, but not until I get your daughter stabilized.  Nurse trying to bag, can you please do it effectively so that her sats are better than the 60s!?  And bedside nurse....WHAT IN THE WORLD is going on??  What do you mean you already gave a dose of ativan...that I hadn't even told you about yet!?

What I Actually Said:  OK, I need to understand better what is going on...when did the seizure start, what medications have been given?  I left shut up out of it, but I probably shouldn't have, because the mom was still shouting, and there were several nurses that kept asking "What do you want us to do!?!?"

The Ending:
I paged my preceptor for a little back-up help.  We repositioned the patient, bagged her up again, and finally her seizure stopped.  Ahh, all is well with the world.  The mom calmed down.  A couple nurses left the room, so it was much quieter.

And all of this happened in maybe a 6 minute time frame from the point of the initial page "She's seizing" to the end.

But it felt like 45 minutes of insanity to me!

Moral of the Story:
My preceptor told me several times that I handled the situation very well.  She said I had a well thought out plan, stayed calm during the time she saw me, and my outcome was effective and what we expected.

But I learned a few things in the situation that I want to improve on in the future.

1.) Turn my mind off.  OK, so this may not impact my situation directly, but I must say if I had been able to get in an hour nap prior to this craziness, my mind may have been a little bit less foggy.  Any ideas on how to do this is much appreciated!

2.) Take control of the situation.  I could omit the "SHUT UP," but next time I certainly need to control the environment better and quicker.  While I knew what to "do" because of my years of a bedside nurse, I couldn't effectively bag the patient while putting in stat medication orders, while hearing the full story and trying to calm the mother down.  Be more assertive. Take better control.

and finally, 3.) Seizures, weird mixed up Stories, and Sleepiness ARE going to happen.  It's what being a PICU APN is about.  It's the situations that get your heart pumping and the adrenaline flowing.  And yet our exterior is cool, calm and collected.

So it was a good night.  A night of learning experiences for sure.  And really, that's what this is all about for me.  Learning how to be a nurse practitioner.  Learning how to be a great nurse practitioner!

So if Seizures, Stories, and Sleepiness are what it takes to get me there, then bring it on!

Call Shift #2 Down

I had my 2nd ever call shift last night, and I must say I am glad it is over!

Being up for 27 or so hours is not easy. Or fun.  Or desirable to me in any stretch of the imagination.

But it happened.

I came home looking beat up.  And my breath stunk.  And I had things on my pants that I didn't know whether they were food, drink spillage, or some patient funk.  Gross!

But I must say that I hit the pillow and did not think twice about falling right to sleep.

And this never happens to me! Usually it takes me awhile to get to sleep.

But not this morning.  Nope, I hit the bed at 10:45 and was asleep before the clock had the chance to hit 10:46.

And then I slept until 4 pm!  WHAT!?  It was probably some of the best 5 hours of sleep I have ever gotten!

And while last night had it's crazy moments and events, I think I'll save that story for later.  But that story will come, because I learned a few lessons on call last night.

For now, I am going to revel in the beauty of what's called sleep.  The way that it makes you feel all warm and fuzzy inside once you get it after being told "No" for so many hours.  And the magical ability that it has in making your mind clear once again.

Ahhh, I love to sleep.  I love my job as a nurse practitioner.  But man, oh, man I love to get me some sleep!

The Look of an APN after a 16 Hour Call Shift

Yeah, that title is deceiving.  A picture of me after my call shift is NOT going to happen.  Let's just say, the ponytail is a bit messier, and the lack of make-up and tired eyes is quite obvious!

I worked my first 16 hour call shift last night...and thankfully, surprisingly to me, I'll still alive enough this morning to tell about it!

I am SOOO not a night person.  My bedtime is pretty much around 9:30 every night...yes, I am an old lady in a not quite 30 year  old body!

When I worked nights for about a year and a half as a new grad nurse, I stunk at it.  I was constantly tired, always hungry (hence the 13 or so pound weight gain in that first year- grr!), and definitely cranky.  So going into this I wasn't very optimistic.

But it actually wasn't that bad!  Don't get me wrong.  16 hours is 16 hours, so it was long.  But it certainly could have been worse.

It most likely is because our team only has 6 patients on it right now, when we normally have 12-15.  And of those 6 patients, 4 were barely an excuse for PICU patients....they could have very well been floor patients.

But regardless, it wasn't that bad! And I'm reveling in it!  I work another 16 hour call shift Wednesday, and am crossing my fingers that it will go just as smoothly.

I must say, 3 hours of sleep never felt so good!

So here's to a good-morning to most of the world.  And a good night to all my on-call overnight nursing and APN buddies!

The Pictures Promised

Happy 7th Anniversary!!!  So this post is a little late, but better late than never, right!?

We celebrated 7 years of a wonderful, fun, crazy, and memory making marriage earlier this month.  I have to say that while the trip was short, it was oh so sweet.


And it was nice to be away from the PICU at bit...something about the crystal clear waters of the Bahamas not being as stressful as the PICU! Go figure!

I love that after 7 years, this man still makes me laugh...a lot!

Nothing like a cold beer, a good book and my feet in the sand!

Enjoying a glass of wine at the Piano Bar before dinner

Enjoying the gorgeous sunny day in Nassau

And enjoying some amazing fresh caught conch salad! Mmmm....

Cruising is the best! Especially with your best friend!

Trying to take shelter on the private island from the crazy storms!

But we clean up pretty well for dinner : )

Back in Miami...so soon!  

It was a great trip...and was the perfect celebration for the last 7 years of an incredible marriage!  I look forward to many, many more!