PICU APN?

Isn't it amazing how fast time just flies by when you are having fun!?  Since I last blogged (7 1/2 months ago!!!) I was placed on modified bedrest at 34 weeks, had a beautiful baby girl, moved to Lawrenceville GA, then moved to Suwanee GA.  Whew!

So here I am, 2 1/2 months after my maternity leave technically ended, and am no longer a PICU APN.  Well, that's not entirely true.  I will always be a PICU APN at heart.  But I am no longer employed by a PICU as an APN.

For the time being, I am enjoying being at home with my baby girl.  My original plan once we got down to GA was to get another job by the time Isabella was 6 months old.  Well, she is now 6 months, and I haven't even put my application in.

Part of this just makes total sense to me.  And part of it still surprises me how happy I am being at home with her.  I have always said that I did not want to be a stay at home mom.  I am passionate about what I do. I thrive in the PICU setting. I do well staying busy and on my toes.

With all this cuteness, who couldn't love staying at home!

And certainly staying at home can be busy too.  Just a completely and utterly different kind of busy.

Staying at home has taught me the importance of slowing down and enjoying the little moments.  It has taught me that rocking my baby through the pain of teething, or just simple fussiness is as important as what I do in the PICU.

It has taught me that while 12 hour days flew by in the PICU without question, 12 hour days at home can too...except I don't have the same work to show for it.  It's amazing how little can be done with a new baby, and yet that can easily be classified under a successful day!

And so here I am in work limbo.  I am still not entirely sure where the next path will lead me in my career.

My plan is to enjoy the holidays with my family, and not worry or think once about a new job.  In a career that is 24/7, holidays not excluded, this is a great change of pace.

Once the new year comes, I will take a look at what is out there.  What I do know is that I would love a PICU position.  What I know more than that however is my family comes first. That means I want something part time, and something where I can be home in the evenings and not a total mama monster, so no night shifts!

I have no idea what is out there.  I have no idea if it will take me one day, one month, one year, to find the next best thing for me.  What I do know is that it will be very weird for me to say anything other than "PICU APN" when someone asks what I do.  And it will be slightly heartbreaking at first.

But, with new priorities come new challenges and new adventures.  So I look forward to where that may take me!

But first, I will enjoy the peace and togetherness of the holidays.  I hope that you take some time to slow down and enjoy this time with your family and friends as well!  I will see you next year!

PICU Midyear Review

It's April which means time for the annual Midyear Review.  It's a time to check in with the manager, go over the goals we set 6 months ago to make sure we're on target for reaching them, and evaluate what we are doing well vs what we can improve.

I've worked in the same PICU for the last 9 years, and really have never had much feedback in the "what we can do to improve" area.

This year, we have a new manager who strongly believes that at least one area for improvement needs to be focused on.  So I knew after talking with several other APNs who already had their review that there would be some legit personality feedback. 

That being said, I had NO idea what to expect going in.  And let's just say when I left, I left with a smile on my face.

Not because I didn't have something to work on.  But because what I had to work on was something not surprising to me...and because of the way that it was presented.

So as my manager started saying "The top area for improvement is"...she had a smile on her face.  She then proceeded to say "I would work on your patience...particularly with the newer fellows."

Now a fairly recent conflict came to mind in which I was extremely frustrated with a fellow who did not act in the best interest of the patient, and didn't follow the plan that we had set out the day before.  Let's just say I walked in that morning fiery and let him know it. 

So I asked if this area of improvement...patience...was based on that particular incident. My manager said "Oh, absolutely not...that situation was 100% called for and the way you handled it was filled with passion for the patient, and a bit of impatience was very appropriate to fight for what was right!"

So when I asked for examples, she simply stated that at times I come up with a plan for my patients, and if the fellow isn't "on my level" I can get impatient with them waiting for them to get there.  

I'm not entirely sure what that meant (or rather, couldn't think of specific examples), but I definitely realize that I can certainly work on patience in general. 

She then proceeded to say that while she can tell that I am impatient at times because she knows me so well, other physicians that provided anonymous feedback were surprised to hear this because I come across and "joyful and pleasant".

We then moved on to the "Additional comments" section and I just had to laugh out loud.  What in the world does "takes no prisoners" mean!?!? 

She laughed and said that a physician gave that feedback and said that I was a very hard worker, and would do whatever it takes to get the best care for my patients...taking no prisoners along the way.  *I'm definitely thinking this was referring to the above incident, that afterwards was fully supported by the APN manager, PICU director, and Critical Care medical director...yes, it was a rather large situation which is why I was so firey!*

So in a way, the impatience is tied in with taking no prisoners. 

As a PICU APN, I love my job.  And I love caring for patients and their families.  I want what's best for them mind, body and soul, and yes I will fight to make sure that happens.  So if a little bit of impatience can help to get that done, I'm ok with that.

However, I know there are areas that I can grow in.  Focusing on areas of my impatience that can have a negative impact on myself and my co-workers is one of them.  I want to be a team member that people enjoy coming to work to see.  Someone who lights up the PICU that can be a dark place at times.  Someone who can admit to their flaws, and change them, or work on turning them into a positive.  

At the end of the day, it was another good PICU Midyear Review.  Probably the best review that I've ever had because it actually gave me something to work on, on top of giving me a ton of encouragement. And while I will definitely work on my patience, I have no plans on "taking less prisoners"....because really, how awesome does that sound!?!?

 

PICU APN...taking no prisoners!

Rounding in the PICU

PICU Rounds are a big part of the day.  It's the time when the APN's can present their patient, summarize what is going on, and then state their plan of care for the day.

Usually I love rounding.  It lets me take responsibility for my patients.  It calls me to think more about them.  And it definitely teaches me a lot.

The other day, I learned a big lesson.  As I was presenting my patient, I got to the summary part, and said something to the effect of: "This patient remains critically ill, has pulmonary and kidney injury consistent with Wegener's disease..." and went on.

Only to find out later in the day that it is now considered a faux pas to call it Wegener's anymore.  Apparently Mr. Wegener was a Nazi, and that just doesn't sit right.  Instead, it's now called Granulomatosis with polyangitis. 

So there ya have it.  You learn something new in the PICU everyday.  This APN certainly learned that she doesn't want to be supporting Nazi's or diseases named after them.  I will definitely not forget that one!

Only One

I have taken care of a lot of kids in the PICU over the last 9 years. 

And yet only one has truly captured my full heart. 

Only one who I was able to see grow up from a six month tiny baby to a four year old man-sized boy.

Only one who I spent countless hours with, took countless walks with, and made countless PICU memories with.

One who helped me fall in love with Dr Seuss books, largely because of the ear to ear smiles that would spread over his face as I tripped over my words. 

One who taught me every word backwards and forwards to Mickey Mouse Clubhouse and certain Sponge Bob episodes.

One who never got tired of my silly rendition of Itsy, Bitsy Spider.

One who taught me just what it means to be a patient advocate, and one that I advocated just like he was my own son.

One who would smile at very few people as they walked into his room, but I was lucky enough to be one of those few. 

One who cried as I left at the end of my shift on multiple occasions.

One who has filled my Nursing Box with more photos, drawings, and cards than any other patient. 

One who helped to instill a true, deep passion for the PICU in me.

One who I am now mourning for.

Heaven truly has gained an extra special angel this weekend. 

While it was much too soon for you to be taken, and I wish for just one more longer lasting good-bye where I give you kisses all over your face as you roll your eyes, I know that this life cannot offer you what you will have in Heaven.

You have thrown off your cumbersome body brace and are running through the streets of heaven.  You have removed your trach and are able to breath freely and easily.  Your voice and precious giggle can now be heard once again.

Know sweet boy, that you are loved. Know that you are cherished.  Know that you are etched in our hearts.  And know that you are so deeply and so dearly missed. 

Rest in peace little one.  

via

"Have You Examined the Patient!?"

Surgeons tend to get a bad rap amongst nurses.  Not necessarily in my institution necessarily (or consistently), but in life, in general. 

They can be known for bad bedside manners. They can be known for being short (in personality, not stature).  They can be known for talking down to all non-surgeon personelle. 

And then there are the rare but fine (oh so fine!)  moments, when one of them just says something utterly ridiculous that you can call them out on!

What was even sweeter about my interaction with a particular surgeon this week, was there were 3 of my collegues listening in on my phone conversation.  As I hung up, they all bust out laughing, and couldn't believe what they had heard.

So enough setting up the story...onto the good stuff!

I had been caring for a four year old girl who had cerebral palsy and several other medical problems. She was severely mentally and physically disabled, was completely non-verbal, can't fix or follow objects, and was definitely on the small side of the growth curve.  I know that's a lot of info, but it comes to be important in a bit.

She came in for pneumonia, but I noticed that she was malnourished, and recommended consulting Pediatric Surgery for a G-Tube for feedings. I was actually shocked that up until this point she had been fed by mouth for so long!

Looking through her chart, she had previously had a swallow study showing that she was aspirating (which was just as I suspected), so this further built my case for needing a GT.

I placed the call, told the surgeon why we were consulting, and he said he would go see the patient later in the day and get back to me.

Just as I was getting ready to leave work, I get a phone call. Reluctantly I picked up, and was so glad I did. 

The conversation went like this:

Surgeon:  "So I went and evaluated your patient.  I also talked with the mother for a bit, and we are not going to place a GT.  She doesn't need it."

Me:  "Umm, I'm sorry, why do you not think that she needs it.  She is malnourished, she has a swallow study showing that she aspirates, and given her underlying medical problems, none of this is going to change anytime soon."

Surgeon:  "Well the mother says that the patient is able to tell her when she is thirsty, and mom gives her water to drink.  She also says when she is hungry and she will get an apple and eat it. She's been doing this for the last four years, and while she may be on the smaller side, perhaps the mother isn't giving her enough nutrition which we can educate her on." 

Me:  (let me preface that I was BAFFLED at this response!) I simply stated "I understand that you had a conversation with the mother and were given that information, but did you examine the patient!?"

This took him back a bit, and he stumbled over a few words and then said, "Well, yes I saw her." 

More adamently I said, "This patient is completely non-verbal...why would we think that she is verbally telling her mother that she is hungry or thirsty!?  She is severely contracted and does not have purposeful movements, so why would we think she would say she wants an apple, reach for it, and then feed herself!?  I understand what the mother told you, but if you spent five minutes evaluating the actual patient, you would understand the reality very clearly."

*This was the point in which my co-workers were laughing b/c I was so in awe of his ridiculous reasoning that I was definitely firm, but remained very calm*

He didn't particularly like this (I'm assumming), because he got really quiet, then didn't really say too much. 

At the end of the conversation, I gently reminded him to go back to the patient, do a thorough evaluation, and then come to a conclusion on whether this child was safe to eat by mouth, and more importantly able to take in the appropriate nutrition that way. 

He agreed, and then said that he would talk to his attending and call me in the morning.

The next morning I get a text page from him saying "Discussed with attending. We will place GT in 4 weeks.  She will need imaging prior to that."

Short, sweet and to the point.

And yet such a sweet, sweet point made by me! 

Just another lesson learned in the importance of truly evaluating your patient. And yes, while parents are a wealth of information most times, sometimes they don't live in a full reality.  It takes our medical evaluation, studies, and judgement to help determine what is best for these patients.

Score one for the Nurse Practitioners...lesson learned for the Surgeons! 

Exhaustion: PICU vs Pregnant!

Hi friends!  I know, I know...I've definitely fallen off the blog wagon. 

The holidays came and went so fast (don't they always), and now I'm still here thinking now's the time to jump back on.

But then work happens and it's been SO crazy lately!  Tons of sick kids equals tons of crazy busy shifts. Which leaves me just flat out exhausted on my days off.

Oh, that and the fact that I'm pregnant!!  Really, I think that's the major contributor the extreme exhaustion, but still...the job isn't completely innocent : )

For those of you that personally know me, you know this has been a very long journey to motherhood.  Four years of dreaming, planning, praying and hoping.  Four years of countless doctor appointments, about a trillion blood draws and medications, and a hormone imbalance and severe clotting disorder diagnosis later, and here we are!! 

So of course I had to start a pregnancy blog that I hope to continue onward and document our little one has he or she grows.

And when I sit down after a really long day in the PICU, I can either get on and blog about how I didn't sit, eat or pee for the last 12 hours, or I can relish in the fact that I'm pregnant and document that amazing journey.

Yeah, guess which one generally wins!?!? (if you're interested: www.littlelerma.blogspot.com)

But regardless, I still love my first blog baby.  And I am still madly in love with the PICU.  So while I may not be as present, or have as many fun or funny stories, I'm not going anywhere. 

Just thought you should know.  Because really I know how patient you all are. And since most of my readers are either family or other nurses, I'm grateful that you just get it.

Shoot, my nursing and APN friends probably log on every great once and awhile thinking, "Oh my schedule is so crazy...I don't have time to read blogs!" only to find out, neither does the writer.  So at least we are on the same page ; )

I do have some stories in the back of my head that I want to share.  And I do have some topics that keep getting asked about (eg: DNP, picking grad schools, studying for boards, etc) that I want to address as well.

So stick with me and we'll get through this crazy, busy life together...one slowly written blog post at a time.  And if you're in the PICU like me, you wouldn't want it any other way!  What's life without some busy, without some crazy!?!? That's PICU at its finest!