Monday, May 28, 2012

The Start to Summer!

It's a well known fact that if you go into nursing, you will work holidays.  There are few exceptions to this, but for the most part, this is the rule.

As a result, I've worked 4 out of the last 8 Memorial Days.  And this year, it was my summer holiday to work again.

Except NOT while I'm on orientation! Holla!  I have to say, the whole "You don't have to work weekends or holidays while on orientation" rule is awesome!

So instead of spending this gorgeous, sunny- albeit ridiculously hot and crazy windy- Memorial Day stuck inside the confines of the PICU, I get to enjoy it at home, with my man!

Now that's a very happy holiday!

I hope that you are enjoying your long weekend as much as I am.  Happy Memorial Day!

Monday, May 21, 2012

These shoes weren't made for walking...

Cuz' this is what they'll do....

I apparently not only walked off the heels of BOTH shoes...but the entire BOTH shoes!  It would appear that I am a PICU walking fool!

I lost the first heel when I was getting onto the train in the morning.  It was a bit awkward being lopsided but it wasn't that big of a deal.  And then the entire sole fell off as I was walking into work.  Yeah that's not embarrassing!  Sorry long line of folks rushing into the hospital doors behind me...I just have to stop in mid traffic and pick up the entire bottom of my shoe that I've seemed to have left beind!

And then the second heel fell off about 5 minutes after that.  Lovely.  People around me must have thought the craziest things as piece by piece my shoes are unraveling.

So i walked around essentially bare footed the entire day.  What's truly unfortunate was that I got 3 compliments on these shoes (at least the top part that was visible!).

Oh well.  Sometimes you find shoes at a thrift store that cost 60 cents and can last a lifetime.  But sometimes you find shoes that cost 60 cents and last about as long.  I think we all know what category these bad boys fall into.  Farewell PICU walking shoes!

Thursday, May 17, 2012

V for Victory!

I'm always one for celebrating the small victories.  And sometimes I make small victories into large, major ones.  

Because I can...because its fun.  But mostly because as a nurse, sometimes you just need some victories...any the midst of all the chaos.

So tonight I had a major victory....epic actually!

It only took me 1 hr and 20 min to get home!

I'm pretty sure it has taken no less than 2 hours every single shift that I've started as an APN, so this is huge!

Small droplet in the large ocean, but such a large victory for me!

And there were other victories this week in my 3rd week as an APN, but I'll save that for later.

For now, I'm going to revel in the traffic-free victory of today.  And the extra 40 minutes that it gives me with my amazing hubby tonight!

Here's to the little things...the small victories that have big payoffs!

Sunday, May 13, 2012

Nursing Humor

Every once in awhile someone will say something really funny in the PICU.  And every great once in awhile, it will be non-medical or non-nursing humor.

But most of the time, the jokes revolve around medicine, or patients, or something nursing related.  Which makes it completely not funny to non-nurses around me.  But it cracks me up nonetheless!

For example, one of the nurse practitioners was presenting her patient during rounds.  The patient had many medical problems, one of which was pulmonary hypertension.  We typically present patients by body systems- so we tell about their respiratory status, what the exam is, and any meds pertaining to this at one time.  Then we move to the next body system.

She started listing the pulmonary hypertension meds (including sildenafil)  in the respiratory section but the attending on service promptly stopped her.  She said that pulmonary hypertension is a primary cardiovascular problem and should be reported in the CV section.

Which then caused about everyone in the group to roll their eyes or make some comment under their breath.  Someone said "Gee, I guess having "pulmonary" as the first word just doesn't mean anything."   Someone added that despite being directly related to the lungs would clearly make it a CV problem (sarcasm greatly noted). And someone else said something about potatoes/poTAAtoes.  I just stayed quiet.

Until one of the only male physicians in the group spoke up and said, "Well I think it is much more appropriate for this to be reported in the genitourinary section.  It is Sildenafil after all!"

To which I couldn't hold it in anymore!  I, along with everyone else in the group, was cracking up!  Now that is some funny stuff!!!

Oh, and to all my family and non-nursing friends, the other name for Sildenafil is Viagra.  Maybe that will help make the joke funny for ya.

Or maybe not.  Maybe only nurses can find the funny in silly little things such as this!

Thursday, May 10, 2012

Liver Transplant Dance

Today was my clinical exchange day with the Liver Transplant team.  I was super excited about this one b/c liver kids are my favorite in the PICU!!!  I was looking forward to seeing what life is like for those kiddos once we send them out of the PICU.

The first part of our morning was in post-transplant clinic.  We saw a bunch of now healthy, non-yellow super cute kids.  And it was fun.

And then we went in to see a patient who was in the PICU for about 7 weeks, waiting for, and then receiving her liver.  While she is 11 years old, she acts like she's about 5 sometimes and can be (as her mom puts it so eloquently) quite the drama queen.

If something hurts a little bit, she screams and yells a lot.  If something hurts a lot, well you can hear her outside the building.

So when we realized that it was 2 weeks post transplant, and time to take out her staples, we knew we were in for it.

And sure enough, the liver transplant APN and I walked in, with staple remover in hand, and she freaked out!  Screaming, flailing all over the exam table, and telling us there was NO WAY we were getting close to her with "those things!"

After much soothing, and working on breathing techniques, and then some distraction techniques (helpful to have a child life specialist in the room!) we started to take out the 39 staples.  Oh what fun those 39 were.

About every 5 or so, we'd take a break from removing the staples and put steristrips onto the incision.  This is where we told her she had to catch her breath, calm down, and get ready for 5 or so more.

Towards the end, with about 14 to go, she was so worked up she was sweating...which she screamed out "OH MY GOODNESS I'M SO SWEATY! This is HORRIBLE!"  To which the liver APN taking out the staples laughed and I looked over and she too was sweating!  And so was her mom.  It was one big sweaty hot mess in there!

But with 14 staples to go, Liver APN started singing a song about each staple.  And as each one came out, she sang and counted backwards.  So naturally, I started dancing.  I mean if someones gonna be singing I might as well be dancing!

After a steristrip break, the APN leaned over to take another staple, and the patient screamed "NOOOOOO!!!!! You CAN'T do this without the dancing! You HAVE TO DANCE!!"  And this was no joke!  Her face was beat red she was so passionate about this request.

So we finished the rest of the staples one by one, each getting easier as we counted backwards and I did my silly little dance.  And after the last one was out, we had a major dance party.  It was awesome.

The patient was able to sit up, wipe her eyes, catch her breath, and say "That was a good song!  And that was a cool dance!"

That, my friends, is the Liver Transplant Dance!  And that is the only way that this APN remove staples from here on out!


Tuesday, May 8, 2012

Palliative Care

If there is one job that I hands down never...ever...ever!!!...want to do, it's Palliative Care.

Throughout my orientation, I have the opportunity to "shadow" APNs from different services to see more in depth what they do.  While I see these APNs in the PICU, it's not their home base, so it's nice to see "what else" they do.

Yesterday I was with Palliative Care.  I left the hospital with full assurance, that under no circumstances should I ever do that again!

It may have been because our day started off in a dying teenagers room.  I cared for this girl all last week.  And she was getting better!  But, she took a turn for the worse over the weekend, and is just receiving palliation at this point.  Hearing her mumble that she was afraid to die while watching her parents try to stay strong for her in a situation I could never imagine to be in was too much.  I had to tune out some of the conversation at one point just so I could hold it together.

We then moved to a six week old who was born healthy.  His mom noticed that he would sometimes look a little bit blue around his lips, so she took him into her pediatrician.  The pediatrician found nothing wrong...other than an ear infection.  So the mother drove to the pharmacy to pick up a prescription and when she checked on the baby in the car seat he was not breathing and blue.  He was pulseless for about 45 minutes, and even though he now has a beating pulse, he does not have a functioning brain.  So here was this perfectly healthy baby who now has a very limited life.

Then we got to go sit in a Care Conference with a family who had to make the decision to withdraw care for their 3 year old daughter.  She has a rapidly progressing degenerative disease with no hope of getting better.  They have to decide whether to take her off the ventilator and let nature take its course, or if they want to put her through a surgery to have a trach and long term vent.  What huge decisions to make.  What horrible decisions to have to make.

There were other patients that we had to follow-up with.  Then there was the phone conference with a hospice center discussing patients who were dying at home.

And then I left.  Feeling sad for these families.  And feeling discouraged that as health care professionals sometimes there is just nothing more we can do.

I don't know how Palliative Care APNs do their job day after day.  To be able to help kids pass away with peace and dignity is a privilege.  And we get some of that in the PICU.  But to ONLY do that is overwhelming to me.

Parents in the PICU ask me all the time how I can work in such an environment.  And every time I tell them that I can do this because I truly do see so much more good than the bad.  A majority of our patients go home happy and healthy.  Only a few in the grand scheme of things do not.

But for Palliative Care, 100% of their patients are not going to go home healthy.  So I give my full respect to the men and women that can make this their specialty!  It is something that I could never do.

Friday, May 4, 2012

Week 2 as an APN

Holy Moly!  This week FLEW by faster than I can believe!

My second week as an official APN is over, and I feel like it just started.  I learned so much this week.  I got to "do" stuff this week.  And of course, I realized how far I have to go before I will even remotely feel comfortable on my own.  But that's what my orientation is for.

Here is a breakdown of what my week looked like:

Monday- boring EPIC computer training for 3 hours that literally taught me nothing useful : ( i learned a whole bunch of stuff I already knew how to do.
-the remainder of the day flew by, and I can't even really remember exactly why.  I did write my first progress note on a patient.  It took me about 25 min.  Can't wait to see how long a full patient load will take me!  I'll be sleeping at the hospital to get stuff done at this rate.

Tuesday: My first time presenting a patient in rounds...hello nervousness!  Looking back, being so nervous was just SILLY.  I have worked with everyone I was presenting to for the last 7 years.  I have natural, non-nervous conversations with them daily.  And yet, there I was super nervous, trying not to show my paper shaking or quivering voice.  And words just don't seem to come natural in this state.  Except for the word "subsequent" which I said about 14,000 times.  Lovely.  I also felt like my face was on fire, but a few people told me it wasn't even red.  Thank goodness!  At least I had one thing going for me.

Wednesday: Second day of presenting in rounds went SO much better.  Oh, and I presented on 2 patients today instead of one.  Yeah my preceptor is moving me right along!  The other newbie said "Way to be a show-off...I'm only presenting one still!"  This was about 2 minutes after my preceptor told the two of us that we shouldn't compare ourselves to each other throughout this process.  Lesson not learned apparently. 

Thursday:  This was a whole day of firsts:  I got my first pager...x4220 (oh the excitement!), I broke my first pager (yeah that didn't take long!)*, I did my first extubation**, got my first awesome "job well done" comment from the attending on service,*** took out a central line and rapid infuser line by myself (teaching the resident how to do so),**** and for the first time this week, did not come home with a bad attitude because of my 2 hour slow commute home!***** Score one for the team!  

*Apparently I'm not a fan of pagers.  That bad boy was thrown to the ground about 5 times his death.  Tragic story really.  May you RIP pager x4220.  Not sure if they will trust me with another one next week.
**While I have been at the bedside for at least 100 extubations, this was the first one I was in charge of.  So much more stress on this side of it knowing that if the patient doesn't do well, I am the one (eventually) responsible for putting the tube back in!  Oh boy!
***Comment from the attending went something like this: "You have done a great job this week.  When I was told that Tuesday was your first time presenting in rounds, I never would have guessed.  You presented the information so thoroughly and effectively.  Great job." Yeah!!
****Taking out the central line and rapid infuser was no big deal...I've done it a billion times as a bedside nurse.  Apparently the nurse taking care of the patient didn't feel comfortable doing it because she never had, so I got to.  And the resident asked if I could show him how because he hadn't done it before either.  I love teaching so this was fun!  And especially in the face of feeling like I am the newbie and don't know anything this was particularly rewarding.  

*****I need to work on my attitude.  Thursday was a huge success in this area!  There is something about being stuck inside a barely moving car for 2 hours that just gets to me.  The husband said Wednesday "We need to figure something else out because this will not work long term."  Point taken!

Whew- so what a week right!?  I can't believe that 2 weeks have already gone by.  But I am very excited to see what week 3 brings!