Saturday, June 30, 2012

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 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 long can her sats be in the 60' she going to be 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 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!

Thursday, June 28, 2012

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!

Monday, June 25, 2012

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!

Saturday, June 23, 2012

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 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!

Wednesday, June 20, 2012

New Hospital Happenings

So we've been in the new hospital for a week and a half now.  I have to say it is quite the culture shock.

The new PICU is SOOO different from our old one.  It's much, much larger even though we have the same number of beds.  There are inner and outer hallways that all take you to the same place, but it's almost like going through a corn maze just to get there.

People are constantly roaming around, just trying to figure out where they are.  Myself included!  I took 3 wrong turns yesterday trying to get to one of my patient's rooms.  A one minute walk turned into about 5 minutes.

Certainly our response time needs to improve.  A code was called over the weekend and it took 4 1/2 minutes for everyone to respond.  In our old unit, it would take max 1 minute for an entire team and then a bunch of others to be crowded in the room.

But not in the new building.  Apparently the team caring for the patient was rounding, and they all tried running through the various hallways trying to find their way to the patient.  The patient had a physician and APN caring for him when the code button went off and everything turned out ok, but still it was quite a long time to get an entire team of helpers there!

Just like anything new, there will be a period of adjustment.  Eventually, we will get used to the labyrinth that we call the PICU.  We will be able to spout off room numbers and know exactly how to get there...and which way is the fastest.

But for now, I'm trying to find the humor in the amount of times that I get lost each day.  Trying to laugh when there are 4 of us trying to get to a room and take 5 wrong turns.  It's the blind leading the blind...or I guess the lost leading the lost.

I am also trying to find the humor in the 6 minutes it takes to catch an elevator...and the 4 minutes it takes just to get down to the main floor.  Being used to a 9 floor building is quite different than a 23 story building!  And yet, waiting for the elevators that seem to never come, laughter is the last thing on my mind.

I will say there are some great things about the new hospital.  First off, everything is new!  Brand spankin', shiny, and new!  Second, the views from the 16th floor (that's the PICU) are amazing!  I can't get enough of the amount of windows that we have, and the gorgeous city I get to look out to.

And the biggest upgrade is my office!  I have an office with 4 other APNs and it's awesome! We all have our own desk with our own computer.  No more sharing.  The old hospital, it was 5 computers in one very small room for 10 APNs.  Yeah that was loads of fun!  

So I'm looking forward to making my desk mine.  Putting up pictures and little things that make me happy to look at when I have some time at my desk.  Once I get there, I'll post a picture.

But I wouldn't count on that happening that soon.  I'll be lucky if I can find my desk, my office, on a daily basis.  Right now, its a successful day if I've been able to make it to my desk and each of my patient's rooms.  Now there's something to certainly strive for!

Sunday, June 10, 2012

Empty Promises & New Beginnings

Haa...I just read the last sentence of my last blog and realized how empty that promise was.

No, I do not have pictures for you this weekend.  At least not pictures of our gorgeous anniversary getaway.  I was lucky enough to upload a few from my phone that would be more appropriate for this post.

I'm not sure why I even thought I'd be able to get to that this weekend.  I knew it was going to be a big one.  Monumental actually!

It was a weekend of saying good-bye, and looking forward to the new beginning starting tomorrow.

Since November 2004, I have walked through the same door to get into work.  Tomorrow I will walk through an entirely different door.

And not just because I'm going in the back way.  I will be walking into a completely different building.

Same job, same people, same PICU.  Confused!?!?

We have moved.  As in, the entire hospital moved 1 day!  In about 14 hours to be exact!

It's something that we've been planning on for the past couple of years. But yesterday it happened.  One of the reasons "The Move" was planned in June is because it is typically a low census time for us.

But not this year!  Oh No!  I can honestly say that in the past 7 1/2 years that I've been there, I've never seen a beginning of the summer so crazy.  And not just the number of patients, but the acuity was also sky high.

So it definitely made for an interesting and exciting day.  But everything went extremely smoothly, if not a bit faster than I was expecting!

Of course, the PICU was the last to get all the patients out, but in all fairness we had the most amount of kids (40!) and some of the, if not THE, sickest kids in the entire hospital!  So there!

I have to say it will be bittersweet walking into a completely new hospital tomorrow.  No longer will we have "the alley."  And there will be no sentiments in the new room numbers.

Every time I walk by 225 or 227 I think fondly of the two little kiddos that I cared for...for almost 3 of the 7 years that I was a nurse!

And then of course there were the rooms you'd walk by and have flashes of things you wish would leave your memory. Children that have passed.  Parents that were grieving.

And then there were the rooms that made you remember, "Wow, we worked as such an incredible team that night!"  and even the occasional "Whoa, that was a CRAZY shift...I can't believe that little one made it out of here alive!"

So I'm am leaving behind a hospital, a building, full of memories.  But I enter the new hospital, the new building, with all those great team members and the same patients.  This makes me confident that while I am leaving behind some really great memories, there will be many more great ones to be made!

We started together as this girl! Now we're both APNs!
 And PS: it was awesome to get to wear scrubs again for the day!
I like dressing up, but you can't beat scrubs for comfort

Wednesday, June 6, 2012


I know, I's been awhile.  But at least I have a good excuse.

I took a few days off last week, from orientation no less!, and the man and I went on a quick little 7th anniversary trip.

It was FABULOUS!  Between the stress of the new job, the craziness of all the infertility stuff, friends moving away faster than I can keep track of, and just life, it was great to get away!

We had been talking for awhile about doing a little weekend anniversary someone nearby...perhaps a B &B, or even a fun hotel in the city.  But then we set our sites a bit higher, got carried away, and ended up in....

Miami beach!  I don't really know what I was expecting, but it was SO different than what you see on tv.  I guess CSI Miami didn't prepare me well : )  But if that's anything like saying Grey's Anatomy didn't teach me how to do the surgery well, point taken!  It was pretty rainy and stormy the entire day we were there, but we still found ways to kick back, relax, and enjoy the free happy hour!

And then we went on a 3 night Bahamas cruise.  The first 2 days the weather was very rainy and very windy...all day.  I was starting to see a (depressing) pattern.  But the last day in Nassau was gorgeous!  I mean picture perfect, crystal clear turquoise water, bright blue sunny skies, perfection!

We made the most of the entire trip...sunny or stormy.  We found time to relax, unwind, and just enjoy quality time together.

I didn't even have one dream of the PICU...which says a lot!  I truly left the PICU behind, fully and completely.  And despite how much I love my job, that is needed every once and awhile!

But now it's back to the PICU grind.  Well, actually, tomorrow it's back to the Cardiology grind, because I'll be spending the day with them.  But the rest of the week through Saturday I will back to the PICU.

I guess if there's anywhere I'd like to "grind" it would be in the PICU.  Except wow, that just took the saying WAY out of context.  So I guess we'll keep it at "Glad to be back to the PICU grind."  Or something like that.  Hope your "grinding" is going well this week! : )

PS: I will post pics...soon...ish!  Maybe after this weekend!?