tag:blogger.com,1999:blog-19026984168718088282024-03-13T10:45:28.865-05:00Adventures of a PICU Nurse PractitionerCrazy tales of life in the PICU...and my life in the real world as a PICU Nurse Practitioner!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.comBlogger242125tag:blogger.com,1999:blog-1902698416871808828.post-79726197732384022842016-09-25T13:33:00.000-05:002016-09-25T13:33:19.101-05:00PICU Adventures continued...<span style="font-family: "arial" , "helvetica" , sans-serif;">Holy Moly! I am back in the work force. Well, I'm technically not back <i>yet.</i> But the contract has been signed, and I have a *tentative* start date of December 20th, because really, does credentialing and privileging ever go according to the perfect timeline that is initially given!? My guess is I will actually start just after the new year, but we shall see.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">While I have thoroughly enjoyed taking off the last 2+ years off to be at home with my girls, I am thrilled to be getting back in the hospital again. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Let me back up a bit though because it's been awhile! </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">We moved across country to be near family when Isabella was just 6 weeks old. I had every intention of going back to work when she was around 6 months old. However, after 2 applications being sent in (1 to an pediatric urgent care, and 1 to a brand new Fertility Preservation Specialist position), and then rejected (the first was filled by an internal candidate the day after posting, the second job was removed all together b/c they didn't have all the details/funds to put it together), I had to put my job hunt on hold because I found out I was pregnant! Happy, happy surprise. </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">While I worked through my first pregnancy, I wasn't thrilled about the idea of looking for a job, going through the interview process, taking 3-5 months to get licensed and credentialed, and then needing to take a maternity leave very shortly after starting. </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">So here we are, almost 2 years later. I have had quite the extended maternity leave, and have loved (mostly) every moment of it with my two beautiful girls! </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">That being said, once I had my second daughter, I told my husband I would start looking for a job when she was 2 or 3 months old, because I just missed it! </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Here's where it starts to get crazy. The week before my daughter turned 3 months old, I looked online for Pediatric APN jobs near my and didn't love what I was finding. I knew I only wanted a part time position, preferably 2 days a week, and knew that I didn't ever want to do nights again. Oh, and no holidays or weekends would be great as well.</span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Not a tall order for a nurse practitioner at all, huh!? </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">So as I'm describing my perfect, ideal, dream job of being a PICU nurse practitioner without having to work nights, weekends or holidays, I realized just how crazy that seemed. There are not PICU jobs like that out there. It is a 24/7 unit, and it needs 24/7 workers.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Then comes a text that would change my life. A former fellow that I worked with in the PICU in Chicago had recently taken a job at the children's hospital near me who was in great need for APNs, and he remembered that I was in the area. He text me stating that he knew I just had a baby and wasn't sure if I had even gotten a job at that point, but wanted to know if I'd be interested in a PICU position.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">I thought, well I've been looking for PICU positions, but the few I have found were either all nights, or 50% nights, and of course included a holiday and weekend rotation that I wasn't interested in that. He asked what I was looking for, and I just threw it out on the table thinking it would be thrown right back in my face.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">BUT it wasn't!!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">I then got a call from the director of the PICU and we had a phone interview. I thought I would tell her my requirements from the get-go (2 days a week, no nights, weekends or holidays), and it would then be thrown off the table at that point.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">BUT it wasn't!!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">I then got an in person interview and met with various physicians and nurses in the PICU. After many of them asked if I was willing to work nights and I told them no, I thought it would be thrown off the table.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">BUT once again, it wasn't!!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">So here we are now...I get an offer letter with 2 days a week, of my choosing, no nights, weekends, or holidays, AND a pay increase from my previous hospital where I had 50% night shifts, 3 holidays a year, and every third weekend!</span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Honestly, it seemed to good to be true. Some days, despite a contract, it still seems too good to be true. </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">I kept waiting for the ball to fall, or something to fall through and them say, "Oh you meant two DAYS a week, we need you two NIGHTS" or something like that. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">But it never did! And yes, I haven't started yet, so there is a chance that it could be a terrible place to work. But from what I hear and the people that I have talked to who work there, it seems like a great place. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Will it be a perfect job without any flaws or concerns? No. Does a perfect job that has absolutely no flaws or concerns even exist. I think the answer is no. Even my last job which had so many amazing things about it, and amazing people to work with, was far from perfect and I certainly had complaints (mostly in the scheduling department!). </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">So for now, while I am in the process of credentialing, I am going to enjoy my time at home with the girls. But I will also continue to be super excited for the new adventure that is ahead of me. I know that I have so much to learn, so much to catch up on, so much to take in before I step back into the PICU! Agghh, 2 years off is a long time!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">But I also know that I am a fast learner, and am willing to take whatever challenge lays ahead of me. </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Oh, and the other major bonus is I don't have to change the name of my blog. Because really, "Adventures of a Fertility Preservation Practitioner" just doesn't sound quite as adventurous! So here's to staying in the world of Pediatric ICU. Here's to dream jobs fulfilled. And here's to the many new adventures that lie ahead of me!</span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">For those of you that have stuck along for the ride all these years (and through my hiatus), thank you. I hope you will continue to keep your arms in at all times, because I'm sure it will be a bumpy ride at first, but I know that it will be a fun one! </span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Here we gooooooo............................................................. </span>Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com17tag:blogger.com,1999:blog-1902698416871808828.post-22800560993681283772015-07-09T09:24:00.001-05:002015-07-09T09:24:51.449-05:00A PICU-less Update!Well, well, and suddenly 6 months have flown by since my last post! Seriously how does that even happen!?<br />
<br />
Well I can tell you life happens, and blogging gets put on the back burner. Especially a blog about being a PICU Nurse Practitioner, which I still am at heart, but not currently employed : )<br />
<br />
Since our move down south last year, I was thoroughly enjoying my time at home with Isabella. My initial plan was to be a stay at home mom for 6 months and then go back. But 6 months came and went so fast. We were buying a new house and moving when she was 6 months.<br />
<br />
So then I thought, ok, let's give it a month or 2 so we can get settled in. Who wants to have a 6 month old, unpack a ton of boxes, furnish a new house, and just get organized all while starting a new job!? But after a month or two of settling in, I will be super ready to find something part time! So over the next couple weeks I applied to 3 positions.<br />
<br />
The first job was the one I felt very excited about! It was a part time, 20 hour a week (2 ten hour shifts) job through the children's hospital down here called a Fertility Preservation Practitioner. It was no nights, no weekends, no holidays, no on call! Schedule heaven!! But even more, I loved the idea that I was still able to work with adolescents and young adults and also be able to combine my experience and passion for fertility help.<br />
<br />
However, HR said that it was a brand new position, and it would take several months to get some details together. Umm, hello, ok...so why post the position now!?.<br />
<br />
Anyways, in the meantime, I applied for an urgent care position that was also part time and about 15 minutes from my house. Although it was some off hours and some weekends, I was ok with that b/c I think that Urgent Care would be interesting, or at least more interesting than some specialty clinic positions that were available. <br />
<br />
BUT then HR called back the very next day saying "Thank you for your application. We have filled the position within 24 hours with an internal candidate. Thanks for your interest and please apply again!"<br />
<br />
Ugh, the technicalities/legalities of job postings is crazy. If you have a person to fill the job, why waste anyone else's time in the application process if you know you aren't even going to consider them!?<br />
<br />
But then, a second urgent care position opened up, once again part time and about 30 minutes from my hose. And once again, it was filled internally.<br />
<br />
I found out a few days later that they were removing the Fertility Preservation Practitioner position for now because they couldn't get together all the logistics of the position at this time, but it was something they were hopeful about for the future.<br />
<br />
So strike 3, I'm out : ) <br />
<br />
No seriously, I was out of the job hunt market, at least for now. Not just because those 3 jobs fell through, but mostly because....<br />
<br />
<div style="text-align: center;">
<span style="color: magenta;">I found out I was pregnant!!!</span></div>
<div style="text-align: center;">
<span style="color: magenta;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBSfAACbg8szUyx86q4EommNRUjoHcf_6aQpi9rmzXLH3IrO8eVqH3PHKXbkIbZQlOSbAYZZBWIJgdjTWJwD5bWQ9u6ia9fYPVVXEGlZh-PuLZlX1xfT2zTwFEAEVgR4MYprZmtLh5nUk0/s1600/12+week+US+%25285%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBSfAACbg8szUyx86q4EommNRUjoHcf_6aQpi9rmzXLH3IrO8eVqH3PHKXbkIbZQlOSbAYZZBWIJgdjTWJwD5bWQ9u6ia9fYPVVXEGlZh-PuLZlX1xfT2zTwFEAEVgR4MYprZmtLh5nUk0/s400/12+week+US+%25285%2529.jpg" width="400" /></a></div>
<div style="text-align: center;">
<span style="color: magenta;"><br /></span></div>
<br />
It was a big surprise b/c with all of our fertility issues before, we didn't think we'd get pregnant so easily and effortlessly...ever! But it happened and we couldn't be more thrilled. I am almost 19 weeks and just chuggin' right along.<br />
<br />
So in the last couple months I have looked a couple times just to see what was out there. I felt like if something was truly exciting or seemed like a great opportunity I would apply. But since I was told it takes 3-4 months to get into the hospital, get fully credentialed and privileged, at this point it doesn't make sense to start a new job that I could potentially be at for a month or so, then need to go on maternity leave.<br />
<br />
So I continue to be a PICU nurse practitioner...at heart, at home : )<br />
<br />
It's definitely not the life turns that I would have expected for myself, but I am truly happy. <br />
<br />
I try to stay on top of some journals so I don't lose all knowledge completely. Plus there is still our Noise Study publication that we are (forever!) working on, so at least I am still involved with some of my PICU colleagues which makes me feel connected. <br />
<br />
And regardless of what happens with my career next year, I look forward to what that will bring. I may not (most likely will not) be in the PICU anymore. Perhaps I will find something in a specialty that rounds in the PICU on their patients, but the likelihood of finding a part time, no night shift PICU postion down here is impossible (as in, they don't exist, b/c all their PICU practitioners do nights).<br />
<br />
Until that time comes though, I will continue to enjoy being at home with my 1 year old, and embracing the fact that as sick as I have been with this pregnancy, I didn't have to throw up in a nasty old hospital toilet...that can be done in the comfort of my own home this time : ) Some things are just far better done outside the PICU!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com4tag:blogger.com,1999:blog-1902698416871808828.post-10141482430022854332015-01-24T13:55:00.001-06:002015-01-24T13:55:19.162-06:00Measures of SuccessWell hello New Year. My, you came fast! In my last post I talked about getting a new job in the new year, and here we are. And yet, in this moment, I am no closer to working then I was back then.<br />
<br />
I will say I did a quick search for jobs in my area last week. Nothing jumped out at me right away, and then Bella started crying so I got sidetracked and haven't thought about it since. Well, a PICU position was posted which got me all excited, but then it listed the 16 hour night shift requirement, and the joy quickly escaped me. So then I stopped thinking about it.<br />
<br />
What I have thought about, however, is how much my definition of success has changed in the last 7 months since becoming a mom.<br />
<br />
<span style="color: purple;">In the PICU, a successful day was going home at a decent hour with my patient(s) still alive.</span><br />
<br />
<span style="color: magenta;">I suppose in the same arena, if I go to bed at night at a decent hour and Bella is indeed, still alive, that's a success. </span><br />
<br />
But I am thinking that this is where the similarities probably end.<br />
<br />
<span style="color: purple;">In the PICU s successful day is not getting blood or any other bodily fluid on my white coat or nice dress clothes. A shower is assumed and not any measure of success.</span><br />
<br />
<span style="color: magenta;">As a mom, a successful day is one in which I take a shower (more than 2 minutes would be nice!) and get dressed (and yes, leggings or yoga pants do count as "dressed!"). A really successful day is getting less than 2 bodily fluids on my outfit by bedtime!</span><br />
<br />
<span style="color: purple;">A successful day in the PICU has built in work-outs as I am constantly moving, and perhaps success is found in moments where I can actually sit.</span> <br />
<br />
<span style="color: magenta;">A <i>really </i>successful Mom day includes a 20 minute dedicated work out.</span><br />
<span style="color: magenta;"><br /></span>
<span style="color: purple;">A successful PICU day involves completing rounds, all procedures, multiple patient examinations, charting, and all phone calls before 6 pm. </span><br />
<br />
<span style="color: magenta;">As a mom, a successful day means I have completed breastfeeding my baby 5 times, and solid feeding her 3 times all by 6 pm. <i>*Let me tell ya, we don't have many successful solid eating days around here!*</i></span><br />
<span style="color: magenta;"><i><br /></i></span>
<span style="color: purple;">In the PICU, a successful day involves giving my patient multiple medications, stabilizing blood pressures, preventing bed sores, having many thought provoking and educational conversations, and providing comfort to family members in distress.</span><br />
<span style="color: purple;"><br /></span>
<span style="color: magenta;">As a mom, a successful day involves remembering to give Bella her Vitamin D drop, stabilizing her booty so she doesn't topple over as she learns to sit, preventing total meltdowns by anticipating her next need, having <i>one </i>conversation that doesn't involve my voice sounding about 5 octaves higher than normal (and something educational would certainly be a successful bonus!), and providing comfort and cuddles to my little one in her moments of distress. </span><br />
<span style="color: purple;"><br /></span>
<span style="color: purple;">After a successful day in the PICU, I leave feeling exhausted, accomplished, thirsty, fulfilled, and like I made a difference in the life of someone. </span><br />
<span style="color: purple;"><br /></span>
<span style="color: magenta;">At the end of a successful day as a mom, I feel exhausted, not always sure of what I accomplished, thirsty, fulfilled, and not entirely sure if I made a difference.</span><br />
<span style="color: magenta;"><br /></span>
Yes, my life is very different right now. Being a PICU APN is hard work. Being a MOM is hard work! And at the end of the day, many times it does not seem like I am as successful as I once was as a PICU APN. Yet I know deep down that this is not true. I know that it takes stamina, knowledge, patience, love, and compassion to be a great mom.<br />
<br />
So I guess while success can be measured in so many different ways, in the end it is the success itself we should be relishing in. Yes, keeping my patient, or my daughter alive is a great success. But it's the intricacies of all the other Mom successes, and PICU successes, that are just as important. <br />
<br />
And until I have career stresses, and successes, once again, I will do just that. Relish in all of the good mom moments. Relish in the days where I know just what I accomplished. Relish in all of the many, amazing Mama successes!<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-4106646466663256802014-12-14T16:14:00.002-06:002014-12-14T16:14:48.543-06:00PICU 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!<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXI-IW6xWlvwB5l7iw0bu5smbE1yqNa43hqiATs45hyphenhyphenc42U1XAj-VEGtaZbhbA2w63zcbDdWihPBy6vo-FupWwleX2hBiWc8mSj_UEOcQcEKD7SX-UnhgI5Es6v8F6EMlJjzHXCTj-Gf0/s1600/IMG_20141104_082021.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVXI-IW6xWlvwB5l7iw0bu5smbE1yqNa43hqiATs45hyphenhyphenc42U1XAj-VEGtaZbhbA2w63zcbDdWihPBy6vo-FupWwleX2hBiWc8mSj_UEOcQcEKD7SX-UnhgI5Es6v8F6EMlJjzHXCTj-Gf0/s1600/IMG_20141104_082021.jpg" height="320" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With all this cuteness, who couldn't love staying at home!</td></tr>
</tbody></table>
And certainly staying at home can be busy too. Just a completely and utterly different kind of busy.<br />
<br />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. <br />
<br />
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!<br />
<br />
And so here I am in work limbo. I am still not entirely sure where the next path will lead me in my career. <br />
<br />
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. <br />
<br />
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!<br />
<br />
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.<br />
<br />
But, with new priorities come new challenges and new adventures. So I look forward to where that may take me! <br />
<br />
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!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com6tag:blogger.com,1999:blog-1902698416871808828.post-32476089724570833382014-04-22T12:11:00.000-05:002014-04-22T12:11:04.387-05:00PICU Midyear ReviewIt'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.<br />
<br />
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.<br />
<br />
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. <br />
<br />
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.<br />
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglLNIKQuvejvbaSD9eWaDF8n-yQmXKUfKZcPDrFVXBq_J0bCxT2pBXgiPzGIQ77vgLGIED4G_WaQqaj99UkBHxNj-2d4ApJGap_aDmXuUxuDzInGXSeBRyiXrAeaUQxEiDVubif6AXQGE3/s1600/20140420_153436.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglLNIKQuvejvbaSD9eWaDF8n-yQmXKUfKZcPDrFVXBq_J0bCxT2pBXgiPzGIQ77vgLGIED4G_WaQqaj99UkBHxNj-2d4ApJGap_aDmXuUxuDzInGXSeBRyiXrAeaUQxEiDVubif6AXQGE3/s1600/20140420_153436.jpg" height="640" width="480" /></a></div>
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."<br />
<br />
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. <br />
<br />
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!"<br />
<br />
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. <br />
<br />
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. <br />
<br />
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".<br />
<br />
We then moved on to the "Additional comments" section and I just had to laugh out loud. What in the world does "<em>takes no prisoners</em>" mean!?!? <br />
<br />
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. *<em>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!*</em><br />
<br />
So in a way, the impatience is tied in with taking no prisoners. <br />
<br />
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.<br />
<br />
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. <br />
<br />
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!?!?<br />
<div style="text-align: center;">
</div>
<div style="text-align: center;">
<span style="color: blue; font-family: Arial, Helvetica, sans-serif;">PICU APN...taking no prisoners!</span></div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com4tag:blogger.com,1999:blog-1902698416871808828.post-20770069290200836042014-04-03T16:26:00.004-05:002014-04-03T16:26:48.467-05:00Rounding in the PICUPICU 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. <br />
<br />
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.<br />
<br />
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.<br />
<br />
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. <br />
<br />
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!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-49776388353339834472014-02-24T20:30:00.000-06:002014-02-24T20:30:22.582-06:00Only OneI have taken care of a lot of kids in the PICU over the last 9 years. <br />
<br />
And yet only one has truly captured my full heart. <br />
<br />
Only one who I was able to see grow up from a six month tiny baby to a four year old man-sized boy.<br />
<br />
Only one who I spent countless hours with, took countless walks with, and made countless PICU memories with. <br />
<br />
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. <br />
<br />
One who taught me every word backwards and forwards to Mickey Mouse Clubhouse and certain Sponge Bob episodes. <br />
<br />
One who never got tired of my silly rendition of Itsy, Bitsy Spider.<br />
<br />
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.<br />
<br />
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. <br />
<br />
One who cried as I left at the end of my shift on multiple occasions.<br />
<br />
One who has filled my Nursing Box with more photos, drawings, and cards than any other patient. <br />
<br />
One who helped to instill a true, deep passion for the PICU in me.<br />
<br />
One who I am now mourning for.<br />
<br />
Heaven truly has gained an extra special angel this weekend. <br />
<br />
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.<br />
<br />
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. <br />
<br />
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. <br />
<br />
Rest in peace little one. <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRzHGtTd0sFdEMVcKrWcGbGE0VxbCFBDEXEhAcXhVOIXXcRt8y4gynUk8gwDHbimEgSg4MBe3GGQo67ytjP0Dix_KSWf3F7jrHI1QmxVt9iZkt9swloR2td_kPkD13udccCjtjNrZpCthj/s1600/child-going-to-heaven.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRzHGtTd0sFdEMVcKrWcGbGE0VxbCFBDEXEhAcXhVOIXXcRt8y4gynUk8gwDHbimEgSg4MBe3GGQo67ytjP0Dix_KSWf3F7jrHI1QmxVt9iZkt9swloR2td_kPkD13udccCjtjNrZpCthj/s1600/child-going-to-heaven.jpg" height="158" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://img.wikinut.com/img/2u77lw1r6.7rl9yy/jpeg/0/child-going-to-heaven.jpeg" target="_blank">via</a></td></tr>
</tbody></table>
<br />
<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-11232718852373608922014-01-31T17:04:00.001-06:002014-01-31T17:05:22.303-06:00"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. <br />
<br />
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. <br />
<br />
And then there are the rare but fine <em>(oh so fine!)</em> moments, when one of them just says something utterly ridiculous that you can call them out on!<br />
<br />
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.<br />
<br />
So enough setting up the story...onto the good stuff!<br />
<br />
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. <br />
<br />
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!<br />
<br />
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. <br />
<br />
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. <br />
<br />
Just as I was getting ready to leave work, I get a phone call. Reluctantly I picked up, and was so glad I did. <br />
<br />
The conversation went like this:<br />
<br />
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."<br />
<br />
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."<br />
<br />
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." <br />
<br />
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!?"<br />
<br />
This took him back a bit, and he stumbled over a few words and then said, "Well, yes I saw her." <br />
<br />
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."<br />
<br />
*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*<br />
<br />
He didn't particularly like this (I'm assumming), because he got really quiet, then didn't really say too much. <br />
<br />
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. <br />
<br />
He agreed, and then said that he would talk to his attending and call me in the morning.<br />
<br />
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." <br />
<br />
Short, sweet and to the point. <br />
<br />
And yet such a sweet, sweet point made by me! <br />
<br />
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.<br />
<br />
Score one for the Nurse Practitioners...lesson learned for the Surgeons! Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com3tag:blogger.com,1999:blog-1902698416871808828.post-22798418977509216792014-01-11T17:26:00.000-06:002014-01-11T17:26:03.395-06:00Exhaustion: PICU vs Pregnant!Hi friends! I know, I know...I've definitely fallen off the blog wagon. <br />
<br />
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.<br />
<br />
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.<br />
<br />
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 : )<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczNxzdmvxKhx5fyGWeVU6GASUSPH15CFNCwM-H6PLvh92i25uadF-r9QuIlGg1DCqj2245Uwh1KslJucLmS5xPoN80PLPDgAGRsNUmeJR3f41aj8jxvYV-SDeOSNXNHSmJfQ3ypDRUdDU/s1600/DSC_0063.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczNxzdmvxKhx5fyGWeVU6GASUSPH15CFNCwM-H6PLvh92i25uadF-r9QuIlGg1DCqj2245Uwh1KslJucLmS5xPoN80PLPDgAGRsNUmeJR3f41aj8jxvYV-SDeOSNXNHSmJfQ3ypDRUdDU/s1600/DSC_0063.JPG" height="320" width="211" /></a></div>
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!! <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDW7Xuq5QV7pX_dVrugUawtUw_I5T118Cs4wU9PVEmUHuLKP1o5GKmFvAwuIuQyySsgLXFrPAw_uFTeiQwCtdlAjgOUhzntFaWK6LnBGMUURg_tslEM0s2aMwP65J3T3uCKX3H_UPaoRCL/s1600/12+week+US+(4).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDW7Xuq5QV7pX_dVrugUawtUw_I5T118Cs4wU9PVEmUHuLKP1o5GKmFvAwuIuQyySsgLXFrPAw_uFTeiQwCtdlAjgOUhzntFaWK6LnBGMUURg_tslEM0s2aMwP65J3T3uCKX3H_UPaoRCL/s1600/12+week+US+(4).jpg" height="320" width="240" /></a></div>
<br />
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.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi93o4qRzPIqWI4TBrxlXBlfib7j4Dl_ZOsXHWH2VOrAPuSJCYxTv-KTdLPPFJzMEy2DSVtpWL3LeVvc7k5QS5UC_9Q3d8BabCxSV3iCjs6ccpqpCLE7smfjcUOSNBSyThHuZF7oVI3xoxy/s1600/DSC_0050.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi93o4qRzPIqWI4TBrxlXBlfib7j4Dl_ZOsXHWH2VOrAPuSJCYxTv-KTdLPPFJzMEy2DSVtpWL3LeVvc7k5QS5UC_9Q3d8BabCxSV3iCjs6ccpqpCLE7smfjcUOSNBSyThHuZF7oVI3xoxy/s1600/DSC_0050.JPG" height="320" width="211" /></a></div>
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.<br />
<br />
Yeah, guess which one generally wins!?!? (if you're interested: <a href="http://www.littlelerma.blogspot.com/">www.littlelerma.blogspot.com</a>)<br />
<br />
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. <br />
<br />
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.<br />
<br />
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 ; )<br />
<br />
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.<br />
<br />
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!<br />
<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com4tag:blogger.com,1999:blog-1902698416871808828.post-60073677286657391632013-12-25T15:15:00.001-06:002013-12-25T15:15:43.542-06:00Merry Christmas!Last year I had to work Christmas Eve and Christmas Day, both 12 hours shifts that turned into about 15 each. <br />
<br />
This year I got a better deal and just had to do Christma Eve. It was supposed to be a ten hour shift but in true PICU Christmas fashion, it turned into a 14 hour. <br />
<br />
I don't know what it is about the holiday times, but the week or two leading up to it seems so chill. And I think, "Oh nice, for one year the PICU will be quiet on Christmas!" And then the holiday hits and it almost knocks you out.<br />
<br />
Yesterday was one of the top 3 worst days of my APN career (only in competition with last Christmas Eve in which we had 16 patients with no other APN or fellow to help me out, and a day last November that 3 of my patients died in 12 hours!). <br />
<br />
It's rough having bad days at work. It's hard not being able to eat, drink or pee for such a long time. And yet I always have to be reminded of what it is that I'm doing.<br />
<br />
I'm working in a PICU that is filled with sick kids, and families that are hurting. At a time when they would love more than nothing else to be home with their little ones opening presents, drinking hot chocolate, and watching Christmas movies, they are instead in a hospital. In a PICU nonetheless. <br />
<br />
And so it makes my horrible day so much less horrible. It's all about persceptive. And it's important to keep that in mind. <br />
<br />
So with that, I hope you have a Very Merry Christmas!! And a special thought goes out to my co-workers who are taking care of our precious little ones today in the PICU. You are truly a light in this world!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com0tag:blogger.com,1999:blog-1902698416871808828.post-51794962809094215802013-12-19T18:16:00.000-06:002013-12-19T18:16:01.212-06:00Old PICU Friend, New PICU RoleFor the last week I've been taking care of a 4 year old, who I was his primary nurse from the time he was 6 months old! He was in and out of the hospital (more in than out) from the time he was 6 months until he was 3 years old. And I absolutely loved taking care of him, watching him grow, and helping him get better each time.<br />
<br />
So I was really excited to see him last week when he was admitted to the PICU (although sad he had to be there for health reasons). <br />
<br />
And let me tell you, while I have been very aware of the differences between my role as a Nurse Practitioner, and my role as it was as a nurse, this week made those differences even more obvious.<br />
<br />
When my boy came in I was able to spend 12 hours at a time with him. We read a lot of books. We watched a lot of Sponge Bob. We took walks in the halls. We just spent a lot of time together.<br />
<br />
But now my role is so different. Even though I may be in the unit for 10 or 12 hours each day that I work, I don't get to spend it exclusively with him. And some days when other kids are much more sick and need much more of my time, I may spend 20 minutes with him at most!<br />
<br />
What a difference!! While nurse practitioner may share the word "nurse" it truly is a different world than bedside nursing. And while I do love my job as an APN, there are some things, certain things, just like spending time with this sweet boy, that make me miss being at the bedside.<br />
<br />
So on the days that it seems like I'm not able to impact this one boy in the same way that I once was, being able to make him smile and laugh when nobody else could, I have to remind myself that with this new role comes new ways to make impacts. <br />
<br />
And while I'm still trying to figure out what that exactly means, I will continue to enjoy my role as an APN...and squeeze in any extra minute I can to read Dr Suess books with my precious little boy!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com1tag:blogger.com,1999:blog-1902698416871808828.post-9766174616549285342013-12-04T15:35:00.004-06:002013-12-04T15:35:56.104-06:00Customer service at its finestI love great service. I love giving great service. And I get even more proud when I see great service at work.<br />
<br />
Since I've been working so many 4pm to midnight shifts lately, which typically means I'm leaving the hospital around 1 or 2 am, I've been taking the free shuttle from the hospital to the parking garage.<br />
<br />
I work in an inner city hospital and while it's not in a "bad" part of the city, it definitely has its moments of crime there. So anytime I can not have to walk the 0.6 miles to the parking garage in the middle of the night, the better. <br />
<br />
There are several different shuttle drivers that work the night shift. But lately I have found my favorite. His name is George, and he is the friendliest, older gentleman. Not only does he pick me up at the front entrance and drives me to my garage, but he goes above and beyond. <br />
<br />
Once we pull up to the garage he always asks what floor I'm parked on (I'm thinking b/c he wants to know approximately how much time to expect me to come out). He then tells me, every time, that he is going to wait right at the entrance until he sees me pulling out.<br />
<br />
And everytime I pull my car out of the garage, there is he waiting...big smile on his face and waving his hand out of the window. <br />
<br />
It's nice to feel taken care of. It's nice to have your own personal security guard taking you to your car, and making sure you get out safe. It's just nice to get great service. <br />
<br />
And while great service is what we strive for at my hospital, truly great service is what is being given my George, the shuttle bus driver!!! Thank you for all you do (this is a general thank you, b/c I'm positive he does not read my blog!). You are a reminder to us all to not only provide good service, but to go the extra mile, go above and beyond, make a difference, and deliver exceptional service!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com0tag:blogger.com,1999:blog-1902698416871808828.post-35629078368986832982013-11-28T11:17:00.001-06:002013-12-01T15:03:03.053-06:00Happy ThanksgivingHappy Thanksgiving! There is much to be thankful for this year. And as I spend the day with family and friends, I will reflect on all that I am grateful for. <br />
<br />
I hope that you all have a safe and blessed Thansksgiving, and year to come! <br />
<br />
And for all my nursing and Nurse Practitioner friends who are giving of themselves in the PICU (and other units today), thank you! Thank you for your hard work, for your servatutde, and the way you selflessly give to patients and families on holidays like today, and everyday! You are much appreciated!Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com0tag:blogger.com,1999:blog-1902698416871808828.post-26680311234230447592013-11-18T16:54:00.001-06:002013-11-18T16:54:08.996-06:00When PICU Parents Get in the WayEver taken care of a patient and you do everything you can for them??? Only to realize that the "everything" list is completely shortened because the parents just keep getting in the way!?<br />
<br />
This hasn't happened to me in quite awhile...until last night.<br />
<br />
Around midnight (yes, great timing...JUST as I was getting ready to leave!), I get a CAT page. I think I've talked about our CAT calls before, but just a little refresher:<br />
<br />
CAT = Critical Assessment Team<br />
<br />
Anytime a physician, APN or nurse on any unit (outside of the PICU) feel that they want a "PICU Consult" or another set of eyes on their patient for recommendations, or perhaps a transfer to the PICU, they call a CAT call. <br />
<br />
Generally APNs in the PICU respond to these calls (although on some days that we are completely slammed, the fellows can step in if they are not swamped as well!).<br />
<br />
We go up, evaluate the patient, and either decide that the patient needs to come down to the PICU, or they are stable enough for the floor service but we can give them further recommendations on what to do. <br />
<br />
While I really was terrified and hated these when I first started as an APN, I'm learning to love them more and more. It really brings out the autonomy and critical thinking out in my practice. And certainly as I become more knowledgeable, they get a bit easier.<br />
<br />
Until last night!<br />
<br />
As I said, I got the page right as I was getting ready to leave. So of course, I wanted to get up there, decide if the patient needed to come down, and get out of there ASAP!<br />
<br />
Almost 2 hours later, I was finally ready to leave for home : (<br />
<br />
So what took so long for a process that typically takes 15-40 minutes???<br />
<br />
The Parents of the Patient! That's what happened!!<br />
<br />
The floor team called the CAT because they were concerned about the patient's neurological status that had been waxing and waning over the last 3 hours that the patient had been there. I was getting the patient's history from the physician which included fevers, headache, neck pain, decreased appetite and overall lethargy for 4 days. <br />
<br />
My next question was what had been done in the ED and on the floor look into this. The answer? "Weeeeelll.....not much." <br />
<br />
I didn't really get it *what do you mean "not much" has been done??* so I re-phrased. Off the top of my head, in a patient with these symptoms, I would be concerned about several things, but the top of my list would be meningitis. Have you gotten a head CT, and done the LP? What about antibiotics??<br />
<br />
So this is where the story got interesting. The ED apparently had to convince the parents of this patient (that sometimes woke up, sometimes not so much!) that he was actually sick! Despite several attending physicians discussing at length with the family, they ultimately refused everything except the head CT (which was normal).<br />
<br />
So no LP, no antibiotics, no further testing! Done. They almost took the patient home, but the ED physicians said they would not allow that b/c their son truly was sick and needed medical attention.<br />
<br />
So here I am, about 6 hours later doing a thorough neurological examination and determining that this patient now needs to go down to the PICU, mostly for hourly neuro checks (which is too much for our floor nurses when they have a larger patient load than PICU nurses). Ohhh boy, the parents did NOT like that!<br />
<br />
Nor did they appreciate that I stated that he really did need an LP. And antibiotics. And once again, they flat out refused.<br />
<br />
In their minds, their son was sick, but was something that he would need to fight out on his own. And they though he truly wasn't <em>that</em> sick. But he was!!<br />
<br />
So it was a very long, very drawn out process to get the patient down to the ICU. Ultimately, I wrote my CAT note (detailing very thoroughly what I had recommended, and that the parents were refusing most of it along the way), and had to hand off this hot mess to the team that would be there the remainder of the night.<br />
<br />
So here are 2 parts of the PICU that can be hard or frustrating:<br />
<br />
1.) When things are unfinished, or unresolved, it is so unsatisfying just leaving, and not really knowing the outcome right away. But for the sake of my sanity, and the fact that I was exhausted, I did leave.<br />
<br />
and 2.) When parents get in the way of doing what you know needs to be done medically for the patient.<br />
<br />
So while I have no idea what happened today, I look forward to going back tomorrow night seeing what was ultimately decided among the family and the medical team. That will help to resolve the frustration of #1.<br />
<br />
As for frustration #2...unless we take over legal custody because the parents are truly harming the child (which is a much longer and drawn out process than sometimes seems necessary!), parents such as this will continue to be parents just like this. And while I can't do anything to change them in the short term, I can continue to try my best to help them understand what medically would be best for their child.<br />
<br />
And ultimately, I will continue to provide the best care that I possibly can for them. Doing everything I possibly can to get this patient back to their healthy former self, and out of our PICU!<br />
<br />
<br />
<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com6tag:blogger.com,1999:blog-1902698416871808828.post-9494742832513118522013-11-12T14:48:00.003-06:002013-11-12T14:50:37.894-06:00PICU VicesI laugh at how frequently the topic of being a nurse practitioner and alcohol go hand and hand. <br />
<br />
I remember when I was referred to a hematologist almost 2 years ago, I had just finished school and hadn't started as an APN yet. I saw the heme APN and she asked, "So have you started drinking yet!? Because if you haven't now, you definitely will once you start working." <br />
<br />
The question took me a little bit by surprise, so I just laughed. I mean Jon and I have always loved wine. Or an ice cold beer on a hot day. Or a good dirty martini (see, I'm no stranger to alcohol!).<br />
<br />
But then I started working as an APN and it definitely took on a whole new meaning. The hematologist APN was right!<br />
<br />
I also have a friend who is a mother of 2, in her 40s, who is now in the midst of nursing school and she recently posted on facebook a status that read something to the effect of "I don't know how I'd get through these classes without X, Y and Z friends...that and our good friend wine. If nursing school doesn't turn us into alcoholics..." <br />
<br />
I laughed as I read it and then commented, "Just wait, if nursing school doesn't turn you into an alcoholic then your first year as a nurse will!" Laugh, laugh.<br />
<br />
And now my co-workers and I laugh at the end of a hard day about whether it was a "one or 2 glass sorta night." Generally, the super hard days that involve note writing at home are the 2 glasses types of nights!<br />
<br />
So it was particularly funny when one of my favorite co-workers called me last night to say that I would be proud of her. While she was pouring a glass of wine after a long day, it was the first time in 4 or 5 days (yes, we celebrate the small victories!). I told her that I indeed was impressed, and asked her what she replaced her wine vice with. Because I KNOW it's not something you just toss to the side without a replacement. <br />
<br />
While I was completely joking in asking this question, she sheepishly replied, "Yeah, I've taken up online shopping!"<br />
<br />
We both laughed so hard!! Oh boy. <br />
<br />
She then replied, "I think I'm going to stick with the wine, because it's definitely cheaper!"<br />
<br />
So I'm not sure what it is about nursing school, nursing in general, grad school or being an APN, but there is a direct correlation with that and wine consumption! Now there's a smart research study waiting to be done!<br />
<br />
<div style="text-align: center;">
<strong>Are you a wine drinker??? If not, what is your post-nursing/APN hard day vice???</strong></div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com1tag:blogger.com,1999:blog-1902698416871808828.post-4668469987314102112013-11-08T17:28:00.003-06:002013-11-08T17:28:54.548-06:00Goodbye Three Things....OK, after 2 short weeks, and one of them not even being on time, I've decided 3 Things Thursday is over. <br />
<br />
YUP, this is coming as no surprise to me...remember what I told you my journals and diaries used to look like? I'm telling ya, a ten year span can fit in about the front 1/3 of a very small notebook!<br />
<br />
I just realized that I don't have the kind of job that I can guarantee to blog on one particular day of the week! <br />
<br />
So instead, as I come up with them, I can do a 3 things here and there. <br />
<br />
Since I started this blog to document the many fun and crazy things that happen in the PICU I don't want to start feeling stressed or obligated to produce something. That's definitely not needed!<br />
<br />
So <span style="color: purple;">Happy Friday</span> instead! I'm working this weekend and am looking forward to it (as much as you can look forward to working on a weekend!). <br />
<br />
I spent 2 days last week spending time with the Neuro Critical Care APN and the remainder of my last several shifts have been evening/nights so I'm excited just to get back into the regular swing of daytime PICU.<br />
<br />
My one true career love...days in the ICU! <br />
<br />
But tonight, it's a date night in with my man. Nothing can beat that!<br />
<br />
<div style="text-align: center;">
<span style="color: purple;">What are you doing this weekend???</span></div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-91129934189136050872013-11-01T10:05:00.000-05:002013-11-01T10:05:19.659-05:00Happy Halloween!In leiu of Three Things Thursday today (since it became Three Things Tuesday this week!), I am simply wishing you a very Happy Halloween! <br />
<br />
Since I don't have kiddos of my own yet, it's always a blast to work on Halloween and see the kids of the PICU dress up. Most kids in the PICU are too sick to participate, but the few that do definitely bring huge smiles to all of us! <br />
<br />
And since I can't post pics of those kids without getting consents and legal stuff, blah blah blah, I will leave you with some pictures of Halloween the Lerma style. <br />
<div style="text-align: center;">
</div>
<div style="text-align: center;">
<span style="color: orange;">HAPPY HALLOWEEN!!!!</span><br />
<span style="color: orange;"></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDj35Fv-YqHC1dfHmEV0WArMtfKFjZBEftklX-WJTpF0UtajKlY9aMKsTD153785aVaXnY2IaQ1TCNd-yJ-F9LZobQOA_S1om7aSV8gEhXJOJiJFpPYRRfhAOXEVMVGQA3PBY_3XMvBOX/s1600/DSCN4513.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDj35Fv-YqHC1dfHmEV0WArMtfKFjZBEftklX-WJTpF0UtajKlY9aMKsTD153785aVaXnY2IaQ1TCNd-yJ-F9LZobQOA_S1om7aSV8gEhXJOJiJFpPYRRfhAOXEVMVGQA3PBY_3XMvBOX/s320/DSCN4513.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Horrible lighting, I know...sorry! But we started the night with amazing loaded baked potatoe soup...YUM!</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzuEKoyaNkOA2w8cHsOSrpTzBQvSI246ZktfStvSLhFRri4AsXz1g6WfEiQnWvBI-RCD30XEIMAr0vRs3K514fI4VuodMcyUvB_EqwO3ideZ04sM7FSU_EWuuCshtbJbkKsGn3FW4r19-e/s1600/DSCN4516.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzuEKoyaNkOA2w8cHsOSrpTzBQvSI246ZktfStvSLhFRri4AsXz1g6WfEiQnWvBI-RCD30XEIMAr0vRs3K514fI4VuodMcyUvB_EqwO3ideZ04sM7FSU_EWuuCshtbJbkKsGn3FW4r19-e/s320/DSCN4516.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Super excited about carving the pumpkin...and determined not to overcut the top so it falls right in like last year : )</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfwrx3X647ek4OJUR9-mxEi9oyaNxafJLief7eO94JywkZn_LBtCkKC4xqw6f05qZWX55chKULaT3uFLPmSiIotKcONctlKRy1nUkRE_dXnkVUsw_g9ZW2nva3EUfLbftyzKH4fBbnvF1h/s1600/DSCN4518.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfwrx3X647ek4OJUR9-mxEi9oyaNxafJLief7eO94JywkZn_LBtCkKC4xqw6f05qZWX55chKULaT3uFLPmSiIotKcONctlKRy1nUkRE_dXnkVUsw_g9ZW2nva3EUfLbftyzKH4fBbnvF1h/s320/DSCN4518.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My spooky dollar store skeletons on our kitchen ledge</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUBM0G0NvRUWypY97VWzwQC1Mbu72eJsXiSdOYpQh2a2BUlnKFYFud4eU06jG4EA0Eev21kHDpaP6JlhIRLocL9qN_qLMe-589F44lMz4Cv1UzkyJw4cYD-kHKKHqBdxjsQ7rNWOKyfmyh/s1600/DSCN4520.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUBM0G0NvRUWypY97VWzwQC1Mbu72eJsXiSdOYpQh2a2BUlnKFYFud4eU06jG4EA0Eev21kHDpaP6JlhIRLocL9qN_qLMe-589F44lMz4Cv1UzkyJw4cYD-kHKKHqBdxjsQ7rNWOKyfmyh/s320/DSCN4520.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ewww. guts, guts, guts! (Sadly, this is the SAME face I've made on halloween for the past 8 years...some things never change apparently!)</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGePOtWvGMpsJyYXrTvOwoipMGKTEhomrUWiYvlDOXJrcvKQWP6PTP4GiIdcsbNE0Ckdcgwx39BSVRgYCoAWvgS609oj-El8ZzCvsVTnSaSl2KZGsVn63JZCvAMiz9ZOnyMPDqsFfUiSEA/s1600/DSCN4530.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGePOtWvGMpsJyYXrTvOwoipMGKTEhomrUWiYvlDOXJrcvKQWP6PTP4GiIdcsbNE0Ckdcgwx39BSVRgYCoAWvgS609oj-El8ZzCvsVTnSaSl2KZGsVn63JZCvAMiz9ZOnyMPDqsFfUiSEA/s320/DSCN4530.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ohhhhh....scary!</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEia_HqGLoUbP22zuAmDdth9QzmO4A3uzZ_HiSpoapoE8VN4AWuHKLUsjzDA-fnqxQQijBNDBT9xZEiJYWLOkP2YpXx-f1g7rKqjTn6ckYS8NsgKXtVBCBiE-FzrLMOdgDEDu9zZJlS6ljCx/s1600/DSCN4529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEia_HqGLoUbP22zuAmDdth9QzmO4A3uzZ_HiSpoapoE8VN4AWuHKLUsjzDA-fnqxQQijBNDBT9xZEiJYWLOkP2YpXx-f1g7rKqjTn6ckYS8NsgKXtVBCBiE-FzrLMOdgDEDu9zZJlS6ljCx/s320/DSCN4529.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">HAPPY HALLOWEEN!!!!!!!</td></tr>
</tbody></table>
</div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com4tag:blogger.com,1999:blog-1902698416871808828.post-55744650838383854552013-10-29T13:39:00.000-05:002013-10-29T13:39:27.438-05:00Three Things Thursday...ahem, Tuesday<div style="text-align: center;">
<span style="color: purple;"><strong>3 Things I'm Loving:</strong></span></div>
1.) Our 3rd annual scary movie and haunted house party went off without a hitch this weekend! We had a blast! We acutally picked 2 movies perfect for the occasion, which let me tell ya has never happened before (Mama and The Conjuring, in case you were wondering). And the haunted house we picked was a major winner- it was in a huge arcade and was 19 rooms of horror, PLUS a 3-D haunted experience which was awesome!! The only downside, I got so wrapped up in the fun I forgot to take a picture of my amazing food and drinks spread...it all turned out so creatively and awesomely (and yes, that's now a word!). Oh well, at least we got a few pics of the friends...and that's what counts, right???<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmnMAkV-Mafy3kTPT9NpCm5yHSyvpSKYIsHpKevN8Y_bzA5hEnATF_4lv9rmNlR2K-lCj9eRs6DHQ__f8QX2CL78yjS-itY-mvaqQx9lya-P_nd1YhAQs6vgOsfGfxHE0N70wINkGlSrrD/s1600/3rd+Annual+scary+movie+and+haunted+house+night!+(2).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmnMAkV-Mafy3kTPT9NpCm5yHSyvpSKYIsHpKevN8Y_bzA5hEnATF_4lv9rmNlR2K-lCj9eRs6DHQ__f8QX2CL78yjS-itY-mvaqQx9lya-P_nd1YhAQs6vgOsfGfxHE0N70wINkGlSrrD/s320/3rd+Annual+scary+movie+and+haunted+house+night!+(2).JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitdy1cXuS-eETehUA4OKPGidGGt2HhLERffnLzzYTJOtr7LMSNBdlBfHYwH_32kpvSiQtNZjqzZFVPTCvcL3ptMjWGqzr86wJtJcHZ0_dobym8eMyOw2v9XLPfYG-UfVknJisRsq16ycmS/s1600/3rd+Annual+scary+movie+and+haunted+house+night!+(4).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitdy1cXuS-eETehUA4OKPGidGGt2HhLERffnLzzYTJOtr7LMSNBdlBfHYwH_32kpvSiQtNZjqzZFVPTCvcL3ptMjWGqzr86wJtJcHZ0_dobym8eMyOw2v9XLPfYG-UfVknJisRsq16ycmS/s320/3rd+Annual+scary+movie+and+haunted+house+night!+(4).JPG" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUMX7dbv1tVqxIkdEeY6baHB2ncUjNjqqP-JbUTDOHjgArw4qT6BC1sFl3B8RjcMMt6flR11hEXXTG6kc4802jORYICIGgmOC2Y6vgExL4W5YvJaP1CW1cfsDyA0zkiSg020m0sfzVxJpH/s1600/3rd+Annual+scary+movie+and+haunted+house+night!+(7).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUMX7dbv1tVqxIkdEeY6baHB2ncUjNjqqP-JbUTDOHjgArw4qT6BC1sFl3B8RjcMMt6flR11hEXXTG6kc4802jORYICIGgmOC2Y6vgExL4W5YvJaP1CW1cfsDyA0zkiSg020m0sfzVxJpH/s320/3rd+Annual+scary+movie+and+haunted+house+night!+(7).JPG" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipbVW7E1t6zKiDBHWYlyqSFwFexiJuY88oL5hxGNSZDAdyQKpZoBDSqV9Le-K6kdBsgcuYzAFqU0hdxudEhBPzUPLW5Ae5NgUoFHhyofw_SlCBqMnUJyjt3Z23HvxqCwxUZDdDZ1Jtd9At/s1600/3rd+Annual+scary+movie+and+haunted+house+night!+(8).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipbVW7E1t6zKiDBHWYlyqSFwFexiJuY88oL5hxGNSZDAdyQKpZoBDSqV9Le-K6kdBsgcuYzAFqU0hdxudEhBPzUPLW5Ae5NgUoFHhyofw_SlCBqMnUJyjt3Z23HvxqCwxUZDdDZ1Jtd9At/s320/3rd+Annual+scary+movie+and+haunted+house+night!+(8).JPG" width="320" /></a></div>
<br />
2.) A little bit of arm bling that I got on MAJOR discount (like $3!), plus free overnight shipping. Gotta love a great bargain! Too bad these aren't very work friendly...I'd likely stab a patient in the eye with the spikes! OK, retract former statement, these DEFINITELY are NOT work friendly!<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisvl70ZYoKsrEsuyW9LcptB51sC0IAmHEWTulug8JDJKgHXxPJixA5JJ-JqEQ0j4TeWYwVNnQYqEeXK72fO-x1N6uR5ndfz5MjWu0XCu-86PX5zqCTB4jaeDkPaYO3M79C7yE6kEhr0Kbj/s1600/bracelet.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisvl70ZYoKsrEsuyW9LcptB51sC0IAmHEWTulug8JDJKgHXxPJixA5JJ-JqEQ0j4TeWYwVNnQYqEeXK72fO-x1N6uR5ndfz5MjWu0XCu-86PX5zqCTB4jaeDkPaYO3M79C7yE6kEhr0Kbj/s320/bracelet.jpg" width="320" /></a></div>
<br />
3.) The pickles I wanted to try <a href="http://www.adventuresofapicunurse.blogspot.com/2013/10/three-things-thursday.html" target="_blank">here</a>...Umm, YES they are AMAZING!! So much so Jon and I have eaten no less than 2 entire jars of them in the last week! I'd love to say we rationed them over the 7 days, but no...we definitely ate the first jar in one sitting, and the second jar the same way! Nothing like homegrown cucumbers turned oh so delicious organic pickles!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVYCLftJHUFNQXlxtLgAZ9ahXpitfB0Vll5GpGJM-zdEViqfC-JFTEIaa3dr1GRf_YqTTycftffORjNcz_VShgVRwwT35XIyTfntES4A-cFlOH4_KAmq4nvkkrs0ouoOFFOyM6QkpUgeau/s1600/pcikles.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVYCLftJHUFNQXlxtLgAZ9ahXpitfB0Vll5GpGJM-zdEViqfC-JFTEIaa3dr1GRf_YqTTycftffORjNcz_VShgVRwwT35XIyTfntES4A-cFlOH4_KAmq4nvkkrs0ouoOFFOyM6QkpUgeau/s320/pcikles.jpg" width="240" /></a></div>
<br />
<div style="text-align: center;">
<span style="color: purple;"><strong>3 Things I'm Loathing:</strong></span></div>
1.) Precious little ones passing away. Heaven gained a new little angel yesterday and while I am so grateful that I can be a presence and support to the family, it doesn't make each and every death any easier. My thoughts and prayers are with the family through this incredibly difficult time. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhALiMBfRNQ7WhQa0thcf1B2t5LI_AYSxVv_lV85-JxYXROcBxwf3GCas4SMK2HdByHHFd1OzZekZbG99hwi4MSZ_8eQxU0ue3gUMtUFd7KNx9HBZNvmpod_XP_i3pOqnMOb9F1pESZZ8/s1600/Feather_Angel_Wings-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhALiMBfRNQ7WhQa0thcf1B2t5LI_AYSxVv_lV85-JxYXROcBxwf3GCas4SMK2HdByHHFd1OzZekZbG99hwi4MSZ_8eQxU0ue3gUMtUFd7KNx9HBZNvmpod_XP_i3pOqnMOb9F1pESZZ8/s320/Feather_Angel_Wings-1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.bing.com/images/search?q=image+of+angel+wings&id=5A939726F424FD400A2A060A983FC8AC950DDE8A&FORM=IQFRBA#view=detail&id=5A939726F424FD400A2A060A983FC8AC950DDE8A&selectedIndex=0" target="_blank">image via</a></td></tr>
</tbody></table>
2.) Open Enrollment Preparation- ohh, my eyes are going blurry just thinking about the chart again! Wouldn't it be nice if there was just a one sized fits all insurance package that was great for everyone! And I love how every year I've been at this hospital they keep increasing the monthly premiums and decreasing the actual benefits that we actually get. Or changing the insurance to companies that stink! So much so that my hospital no longer accepts patients with OUR insurance!! They will let employee's children be seen here, but nobody else with our subpar insurance will be accepted. That's a lovely message to employees, huh!?<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB1lTjLu5J3dUVETTzjSmFp96VtuFgQhsCEHbbHuOgPTmD-oviOHSnb2U8hfVAW0KUWZ0gIPJ667-_vCP2bim1QRzlRv5wED3R950qQhEQVKs8pB-yW-Leeg7a96g5_RcYdarpzx-k_f1N/s1600/insurance.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB1lTjLu5J3dUVETTzjSmFp96VtuFgQhsCEHbbHuOgPTmD-oviOHSnb2U8hfVAW0KUWZ0gIPJ667-_vCP2bim1QRzlRv5wED3R950qQhEQVKs8pB-yW-Leeg7a96g5_RcYdarpzx-k_f1N/s320/insurance.jpg" width="240" /></a></div>
<div align="left" class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: left;">
3.) The fact that the second installment of Three Things Thursday is being posted on Tuesday. Yes, I knew this would happen. You should see my journals from high school, college and early married years. There's like 7 entries spaced out over a 2 year span, and then about 200 blank pages. Oh well! Three Things Tuesday it is this week!</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com0tag:blogger.com,1999:blog-1902698416871808828.post-49102165413206426532013-10-21T11:10:00.000-05:002013-10-21T11:10:14.864-05:00Psychic in the PICULately, I think I'm psychic. <br />
<br />
And I know what you're thinking. Because I thought it too. I'd see commercials for psychics and roll my eyes. <br />
<br />
But let me tell you, I'm starting to change some of my habits in the PICU because of this new little trait I've inherited...or honed in on.<br />
<br />
You see, it all started a couple of weeks ago. I was working a night shift, and there was actually a little bit of downtime. So I decided that I would look up a topic of interest and educate myself a bit. <br />
<br />
We hadn't admitted a patient in DKA (diabetic ketoacidosis) in awhile, so I thought I'd start there. After about 30 minutes of reading, I got a call from the fellow working with me saying we were admitting a patient in the ED. <br />
<br />
The patient was 4 years old, new onset diabetic, in DKA. <br />
<br />
Weird!<br />
<br />
Then about a week later, during the day, I was sent several research and educational articles from an attending to read. I decided that I'd read about status asthmaticus and adjunct therapies used in the PICU. <br />
<br />
Lo and behold, an hour later, guess what type of patient I admitted!? An 8 year old in status asthmaticus.<br />
<br />
Only 3 nights later, I was on call with one of my favorite fellows. We had a little bit of time to sit down, and I jokingly told her that I WAS NOT going to look up a topic because we would inevitably get that admission a short time later. She laughed at me and rolled her eyes (just like I did with psychic commercials!). <br />
<br />
So she asked what procedure she would like me to review with her instead, and I said Lumbar Puncture. I hadn't done one in about 9 months, and felt like I needed a refresher. So we reviewed the quick procedure. Then we started talking about LP results and diagnosing meningitis (viral vs bacterial). So I started looking all that up and refreshing myself on taht information. <br />
<br />
And I'm not even lying...less than 10 minutes later we get a call saying we were admitting a kid from an outside hospital with likely meningitis!<br />
<br />
What the <em>what</em>!?!?<br />
<br />
So I'm not sure what's going on here! I'm batting 3 for 3. And really, it's 3 for 3...because we've been so busy lately there's been no other time for reading during my shifts!<br />
<br />
You may call me psychic. You may call me crazy. You may call me lucky. <br />
<br />
But whatever you call me, I call it...well, I'm not sure what to call it. But I think the lesson here is to start looking up "colds" or "varicella"...something that will not lead to such a crazy busy shift! <br />
<br />
Or maybe just read about "instant weight loss" or "being a natural at running marathons and enjoying it". That wouldn't be too shabby of a delivery 10 minutes after reading it, huh!?<br />
<br />
<div style="text-align: center;">
<strong>What would you read about if you knew it would come to pass shortly after???</strong></div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-90412919248208663112013-10-17T15:26:00.002-05:002013-10-17T16:59:45.357-05:00Three Things ThursdayIn an effort to improve my consistency in blogging (because I really do enjoy it, and particularly enjoy reading things from a year and 2 years ago!), I have decided to start what I will call:<br />
<br />
<div style="text-align: center;">
<strong><span style="color: magenta;">3 Things Thursday</span></strong></div>
<br />
So every Thursday (or as many as I can remember!) I will present 3 Things that I love from the week, and 3 things that I loathe from the week. It may or may not pertain to the PICU. Some days there is just nothing to love within the confines of those walls. And other days there's nothing to loathe (LOVE those days!).<br />
<br />
And thats ok because really, a nurse is not <em>just</em> a nurse. There's a whole other life once she (or he) leaves the doors of that hospital.<br />
<br />
So enough introduction.<br />
<br />
Here's the first installment of Loving & Loathing 3 Things Thursday!<br />
<br />
<span style="color: purple;">LOVING:</span><br />
1.) Peaceful, quiet moments in the morning with my homemade pumpkin lattes, great books, and a chocolate hazelnut candle!<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkwlXwUIGdnM8Fm5kj1aW_Aqax0RP_0B4QIN14WnhvdfQtnnn-ctRp0Sxml2cLMmv0hc8DN_j4kMU_7xDQWn90FnTMwZQC5aJ8fII1J88qUFex2RsXXGrBrW6qFX2qtF_Rwj6F9WBJNxjR/s1600/20131015_074947.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkwlXwUIGdnM8Fm5kj1aW_Aqax0RP_0B4QIN14WnhvdfQtnnn-ctRp0Sxml2cLMmv0hc8DN_j4kMU_7xDQWn90FnTMwZQC5aJ8fII1J88qUFex2RsXXGrBrW6qFX2qtF_Rwj6F9WBJNxjR/s320/20131015_074947.jpg" width="240" /></a></div>
<br />
2.) Having the best husband in the world. I mean seriously, who else would do this when you were getting ready to have a minor surgical procedure early on a weekday morning!?!? Kept me laughing the entire time waiting!<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1MvpzwSynH4AVmmeKqcc-SxwLd-2F3-TkxAwtugkonaTOthbpG01TbjOJxWAUnL_GTHENd9YpHqkkwuXqKMKkf6pBq_hN692YrQ9PPGa4k5jHbtVI2qxCJCn_5byFBzZSFoYMnYJhOIoF/s1600/jonny.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1MvpzwSynH4AVmmeKqcc-SxwLd-2F3-TkxAwtugkonaTOthbpG01TbjOJxWAUnL_GTHENd9YpHqkkwuXqKMKkf6pBq_hN692YrQ9PPGa4k5jHbtVI2qxCJCn_5byFBzZSFoYMnYJhOIoF/s320/jonny.jpg" width="240" /></a></div>
<br />
3.) The football themed Peanut Butter Cup Chocolate Fudge Brownie triffle I made for our last football tailgate over the weekend! Oh yes, it IS that good. This was the second time I've made in it the next couple of weeks!!<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1iFACdwzaGEqfWLrVHfXjH0RHw_a0fYycc0k0DqlTqvWGBO-ZS7gfddSQjg6CDZmEJ80YpOfLlZOCHI6kzNdMaGpdIzZXbHFCihEHV6oN3OHA492v6gclq3fx2Ud-P3WGkCvvLoXqeIQg/s320/football.jpg" style="margin-left: auto; margin-right: auto;" width="240" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;">sorry for the bad picture quality....camera phone not at its finest!</td></tr>
</tbody></table>
<span style="color: purple;">LOATHING:</span><br />
1.) Waiting in the doctors office for over an hour this morning just to be seen for all of 5 minutes. On the up side, I have now officially "pinned" about a trajillion new recipes to try! (below are the two I am going to do today!)<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYchYMI0B7rK3lIRiV4H79wOlEiljGrFZe1SO76ffzah364hyphenhyphen4LNMjuvnMfSADcKbcFQmdr3T_viZoIQZV_BSEhIunDHyujy7NzDB6doWX7lhDggJgDqTy9SPtRm0hxfLBc5jmNxfNzy_3/s1600/strawberry-shortcake-muffins-main.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYchYMI0B7rK3lIRiV4H79wOlEiljGrFZe1SO76ffzah364hyphenhyphen4LNMjuvnMfSADcKbcFQmdr3T_viZoIQZV_BSEhIunDHyujy7NzDB6doWX7lhDggJgDqTy9SPtRm0hxfLBc5jmNxfNzy_3/s200/strawberry-shortcake-muffins-main.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://dashingdish.com/recipe/strawberry-shortcake-muffins/" target="_blank">courtesy of</a></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY2Rn9r9nUpOl23Tu71k9g6sW0xTrFoxlKpm55lEtX3T632O8HdFNOo2RE9-yjm138hdyihG3U4HkMJ_e_w7DvJQ5Y2F5EJaJNVae4HyA-4BgmIK-GjwRY4szLOYP_cB8KGP-i7jC0OlGJ/s1600/pickles.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY2Rn9r9nUpOl23Tu71k9g6sW0xTrFoxlKpm55lEtX3T632O8HdFNOo2RE9-yjm138hdyihG3U4HkMJ_e_w7DvJQ5Y2F5EJaJNVae4HyA-4BgmIK-GjwRY4szLOYP_cB8KGP-i7jC0OlGJ/s200/pickles.jpg" width="143" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://acountryfarmhouse.blogspot.ca/2012/08/refrigerator-pickles-with-bite.html" target="_blank">courtesy of</a> </td></tr>
</tbody></table>
2.) The cold we weather that came through today and looks like it's here to stay..BRR! I was SO loving the warmish fall we have been having here. Guess it had to end some time!<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgluBqwUQMNPsjCuCjfgpuMhQ5Bes6Q1ySfz6LgYdyIGWHHxLm0f1Aku5XQ2IcVGYZ8MY09_pK5Y04rVhtez8gI-r0yhj5wCk7aHJnT_gddljIEA7zcDVmW3tWUCTxuFc5ojD7vH1DAhw8N/s1600/fall.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgluBqwUQMNPsjCuCjfgpuMhQ5Bes6Q1ySfz6LgYdyIGWHHxLm0f1Aku5XQ2IcVGYZ8MY09_pK5Y04rVhtez8gI-r0yhj5wCk7aHJnT_gddljIEA7zcDVmW3tWUCTxuFc5ojD7vH1DAhw8N/s320/fall.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">*So you can't feel the cold...but can you see it in the grey skies!?*<br />
<div align="left">
</div>
<div align="left">
<span style="font-size: small;">3.) Politics in general...it's just not my thing. But what's really getting me this week is the exorbitant amount of it that keeps inundating my favorite tv shows and the internet! I know I should be a little more up to date with some of the things going on, but really!? Can't we all get along! Obviously not!</span></div>
</td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: 1em; margin-right: 1em; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWiXHhqs17FuNVk4vNJRpRrsy_1010tcVap4ADHfd3d1iPQKf1bzBuRfH1kMwgdZuebHp5dEsW74Hny3hTL2YF3APc-SvFrhsIkav-2rzZdDwgoABuoReYOFE0tJMY-A2nhtqpQ4aW9hrl/s1600/thewhitehouse.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWiXHhqs17FuNVk4vNJRpRrsy_1010tcVap4ADHfd3d1iPQKf1bzBuRfH1kMwgdZuebHp5dEsW74Hny3hTL2YF3APc-SvFrhsIkav-2rzZdDwgoABuoReYOFE0tJMY-A2nhtqpQ4aW9hrl/s320/thewhitehouse.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.bloggernews.net/wp/wp-content/uploads/2009/01/thewhitehouse.JPG" target="_blank">courtesy of</a></td></tr>
</tbody></table>
<br /></div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com2tag:blogger.com,1999:blog-1902698416871808828.post-86035592249063346272013-10-14T16:38:00.000-05:002013-10-14T16:38:17.061-05:00PICU Call Rants #1 and 2<strong>RANT #1:</strong><br />
<br />
First of all, let me start this post with saying how much I hate saying "call shifts." In the PICU, I am not "on call." I am present, for the entire shift.<br />
<br />
I am not able to sit at home, on my couch, or sleep in my bed, and simply answer a phone to give a nice quick answer to the nurse calling about a patient.<br />
<br />
I am there, in the PICU, generally running around, barely getting to sit down, sometimes not getting dinner, and many times not drinking enough water to produce adequte urine output. <br />
<br />
I wish we'd just call it night shift. Because really, that's what it is. Well, a combination afternoon and night shift. But either way, that sounds better than "Call shift"....because that's NOT what it is!<br />
<br />
Rant 1 over...phew! Although it will lead me into Rant #2....<br />
<br />
<strong>RANT #2:</strong><br />
<br />
The REASON why we don't call it night shift! I had a manager tell me in the last several months that calling it night shift (AKA: I hate working nights! Night shift sucks!...sorry that's generally how the phrase comes up from me) referred to bedside nursing.<br />
<br />
Huh?? <br />
<br />
I was supposed to call it what it "was"- "Call shift." Why??? Because that's what the medical model called it.<br />
<br />
OK, there's some crazy, slightly ironic reasoning if I've ever heard it! <br />
<br />
First of all, I AM a nurse! I may be an Advanced Practice Nurse, but I am a NURSE! So calling it a night shift, which could have a <em>nursing</em> connotation would be appropriate! <br />
<br />
Second of all, I did not go to medical school. I am not a physician. So do I really care if I am following the medical model, or using medical terminology (no, not at work, but in situations such as this!)???<br />
<br />
I'm realizing more and more lately that being an APN is a weird chasm between two worlds. We are not quite nurses anymore, but we are not quite physicians either. I function exactly the same as the fellow physicians in the PICU, and yet I'm not a fellow. I have nursing in my title, and was a great bedside nurse for 8 years, but no longer function in that way. <br />
<br />
And I take great pride in being a nurse. Families and patients call me doctor all the time, and I very quickly correct them. Not because I feel I'm not "worthy," but more because I know that patients and families see a big difference between the care that they get from me and my fellow APNs vs some of the residents or other physicians. And I want them to continue to differentiate the two. <br />
<br />
What a weird chasm to be in- in one world, but a part of another. But as weird as it in, and as with all things nursing and APN related, I know that I will figure it out. Figure out how to be an incredible APN in a medical model while still holding tight to the values and traits that are exclusive to nursing. figure out how to continue to differentiate ourselves as APNs from the physicians.<br />
<br />
But most importantly, figure out how to get everyone else on board on calling a cat a cat, a dog a dog, and a night shift a night shift!<br />
<br />
<br />
<br />
<br />Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com4tag:blogger.com,1999:blog-1902698416871808828.post-35675335073935046702013-10-10T13:01:00.002-05:002013-10-10T13:01:21.624-05:00Turning PICU dislike into like...or even love!<br />
So apparently I'm a stinky blogger lately. I really had great intentions to get right back to it, and chronicle all of the adventures lately, but then life just happens.<br />
<br />
Ever happened to you??<br />
<br />
You know, you create a "To Do" list with expectations that come the end of the week, the month, whatever, and all your items will be checked off. And then that time period ends, and you have one check mark (if you're lucky)!<br />
<br />
Grr, I hate when that happens.<br />
<br />
And no, I'm not saying that writing my blog is a burden or even ever on my To Do list. Although I think if I put it there, I might have an improved writing rate!<br />
<br />
Either way, life happens, it gets in the way. Moving on.<br />
<br />
The PICU has been crazy busy lately. Like CRAZY busy! We not only have a high census, but we have a higher acuity than we have in a long while. And this generally happens in the winter with summer time being a bit slower, but it's happened earlier than I remember it in past years.<br />
<br />
That translates to staying late for a lot of shifts. Coming home and wanting to just collapse on the couch only to have notes still to write. And call shifts that turn 16 hour nights into 18 or more without sitting down, eating much, and barely peeing. Yeah, that can't be good for ya! <br />
<br />
We've seen a TON of meningitis lately. I've gotten to do 3 LPs in the last 2 weeks because of it. It's definitely been a great time to be able to get more procedures for sure. And I'm liking procedures more and more. <br />
<br />
Someone asked me several months ago if I "loved procedures!?!!?" To which I really had to answer, "Umm, sure, I guess." It's not that I dislike them. I just couldn't say that I "LOVED" them!<br />
<br />
I think it's mostly because we don't get procedures all that often in my institution because there are several APNs on one shift, working with a fellow. Anytime we're on call or day shifts with first year fellows, they get priority in procedures. Or if a second or third year "needs" more of whatever procedure, they get priority over us as well. Plus, we let intervential radiology put in a lot of our central access, so that drastically decreases the amount of lines getting placed in the PICU. <br />
<br />
But I've decided that the more procedures I get to do, and the better I get at them, the more I enjoy them. <br />
<br />
I guess that's probably true with many things. I don't enjoy bowling, but it's b/c I'm pretty lousy. On the other hand, I love soccer, ping pong, volleyball, etc. But I'm also pretty good at that. <br />
<br />
So I guess if we're going to be insanely busy in the PICU with crazy sick kids, I'll relish in the fact that its an opportunity for me to get more procedures. And for me to get much better at them! Which in turn, will most likely increase how much I enjoy doing them. <br />
<br />
Unless its placing chest tubes...b/c I just hate that!!! Even if I were a chest tube pro...ugh, that's the one thing that just grosses me out. But that's a different story for a different day.<br />
<br />
<div style="text-align: center;">
<strong>What's something that you are learning to love, or like a little more, as you get better at it? Could be in nursing school, as an APN, or just in real life???</strong></div>
<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com3tag:blogger.com,1999:blog-1902698416871808828.post-37614715472015029092013-09-09T19:06:00.001-05:002013-09-09T19:06:52.312-05:00July in the PICUJuly was a big month for me in regards to my career in the PICU.<br />
<br />
I didn't work for 2 whole weeks!! <br />
<br />
And while that sounds counterintuitive as to how that could be huge for my career, it truly was. Because while I wasn't physically working in the PICU, I was working in Prague, Czech Republic.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirEvZc1vUWUA6-XHif9GF9A28W5K5P-SETx_hUeLBJ318z7rXeGwNKLi5LKVYNhXXIAq83mziIzDe3TMv2oHdSXkF0RSNw6Al36HxgLfgjolPzvSJhR8LoZqzdCh1Bt9NqMqzSvHozWB4r/s1600/DSCN3757.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirEvZc1vUWUA6-XHif9GF9A28W5K5P-SETx_hUeLBJ318z7rXeGwNKLi5LKVYNhXXIAq83mziIzDe3TMv2oHdSXkF0RSNw6Al36HxgLfgjolPzvSJhR8LoZqzdCh1Bt9NqMqzSvHozWB4r/s320/DSCN3757.JPG" width="320" /></a></div>
That's right...July was the BIG Noise Study Poster Presentation at the Sigma Theta Tau International Nursing Research Conference. I'm not going to say too much about it in this July recap because I will have a whole post on it, but it was an incredible experience! <br />
<br />
I was able to meet a lot of great people, from a lot of different countries. I was able to get my feet wet with poster presenting. And hello, I was able to go to Prague!<br />
<br />
After Prague, Jon and I headed off to Italy where we were able to spend about 2 days in Rome, and a week in Cinque Terre. We stayed for 3 nights in Vernazza, and 3 nights in Monterosso. All I have to say about Cinque Terre now is if you haven't been, you MUST go. It needs to be on everyone's top 3 places to visit before you die list!<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBzY3oNvvv6JGV_JqPj0l0xWC-gXaRb1lpBx9su-2usSN1kE1XS9yLZ0QqqMMteveMrgPPRIuu42tc8HU9S22eAD9d3LSt_DQBDL7x_Kgl83pBz-0KyRnWJCl4aHD49NY8Ei81-nLnH71j/s1600/DSCN4312.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBzY3oNvvv6JGV_JqPj0l0xWC-gXaRb1lpBx9su-2usSN1kE1XS9yLZ0QqqMMteveMrgPPRIuu42tc8HU9S22eAD9d3LSt_DQBDL7x_Kgl83pBz-0KyRnWJCl4aHD49NY8Ei81-nLnH71j/s320/DSCN4312.JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIbwTDEumI-nFjscbFXfnv0f0teEDKVrQzxhCXIiEiTGz-J2X10cmtep_Zvh7X6M7P0UP9Af2RGx2NVRFzpfqWTzR9mn96FM7Dwfp1os2AibvwHLsAkeZ3rhsevaxyCJyDN-WiqOBXLjQp/s1600/DSCN4322.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIbwTDEumI-nFjscbFXfnv0f0teEDKVrQzxhCXIiEiTGz-J2X10cmtep_Zvh7X6M7P0UP9Af2RGx2NVRFzpfqWTzR9mn96FM7Dwfp1os2AibvwHLsAkeZ3rhsevaxyCJyDN-WiqOBXLjQp/s320/DSCN4322.JPG" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZQBbeKoSRpUguD3-kbRvV64AC1crjvhF6wFv2fYR-nLUEhQaF83MT09WKDG88hp9FUbZ1yUy-xPltjaN4dD3YE7StmExJsxUbop8pi5gQlFlfhHdYy6J7sUVDSJJ-kw0kPRFBJPay4HLS/s1600/DSCN4182.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZQBbeKoSRpUguD3-kbRvV64AC1crjvhF6wFv2fYR-nLUEhQaF83MT09WKDG88hp9FUbZ1yUy-xPltjaN4dD3YE7StmExJsxUbop8pi5gQlFlfhHdYy6J7sUVDSJJ-kw0kPRFBJPay4HLS/s320/DSCN4182.JPG" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: left;">
Outside of traveling, there were some other highlights of July. But let's not kid ourselves...nothing that could compare to Prague and Italy!</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="separator" style="clear: both; text-align: left;">
We started the month by spending a relaxing 4th on a rooftop in the city with some good friends, a once in a lifetime view of fireworks from about 45 towns all at once (unless of course, we go there next year!), an amazing homemade rubarb pie, and a few glasses of good wine. Now that's a good 4th to me!</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1g8SlV2wg41eT09aVuizNlEU4mITJgCUsxSJo9xN1a3Ey-TsqvNU2-n-Dsr9sw_9sFSdup35MTcUBNLS0oZ2QPQ4U8xJ_cT6_A1WqEmbIa-JEGXzZc-jD87PZoB8pnq1CVdsMSwgHmxpz/s1600/July+4,+2013+(2).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1g8SlV2wg41eT09aVuizNlEU4mITJgCUsxSJo9xN1a3Ey-TsqvNU2-n-Dsr9sw_9sFSdup35MTcUBNLS0oZ2QPQ4U8xJ_cT6_A1WqEmbIa-JEGXzZc-jD87PZoB8pnq1CVdsMSwgHmxpz/s320/July+4,+2013+(2).jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEha8PFL4Mv6rhEbewsNMW4viCdIY0FSoyaYc11dUMzdzliLiFVxe_0jPsq6l4suVz9JBblO5gQDksxidp8VfV5isD9i47ooEgMJmHNF3ulknr8M4Rov_WFEFHks3uo0EtRV3z8MYK8eDgr9/s1600/July+4,+2013+(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEha8PFL4Mv6rhEbewsNMW4viCdIY0FSoyaYc11dUMzdzliLiFVxe_0jPsq6l4suVz9JBblO5gQDksxidp8VfV5isD9i47ooEgMJmHNF3ulknr8M4Rov_WFEFHks3uo0EtRV3z8MYK8eDgr9/s320/July+4,+2013+(1).jpg" width="240" /></a></div>
I then went on the next week to participate in the 4th Annual Critical Care Bootcamp. It was my second time participating, and let me tell ya it was about 1000 times better this year! Myself and one of my co-workers who started about a year before me were initially signed up to learn how to be instructors for upcoming years, but we were signed up too late. So we went as participants. And while we were both initially dreading it, it was actually a fabulous learning experience.<br />
<br />
As uncomfortable as Simulation Labs can be (who wants to pseudo-take care of a manequin that talks to you while the rest of the class is watching you through the one way mirror!), they take you so far outside your comfort zone that you truly remember those lessons! <br />
<br />
And it was also very exciting to see how far I've come in the last year. I've grown in my confidence, in my knowledge, and in my patient care overall. Since the rest of the group were brand new APNs and fellows, for the first time ever, I actually felt like I had a bit of a leg up. It was a short, small...very small, leg, but I'll take it. That never happens, so yes, I relished in it just a bit : ) <br />
<br />
So there ya have it. PICU in July. You know, a little bit of Bootcamp, a little bit of holiday partying, and oh a little trip to Europe!! <br />
<div style="text-align: center;">
</div>
<div style="text-align: center;">
<span style="color: purple; font-family: Georgia, "Times New Roman", serif;">What crazy, fun, memory making things did you do in July???</span></div>
<br />
<br />
<br />
<br />
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com3tag:blogger.com,1999:blog-1902698416871808828.post-67204707094597244442013-09-05T18:41:00.001-05:002013-09-05T18:41:06.846-05:00The PICU in JuneI figured since I'm so behind on my blogging, I'd do a few summer recaps on the PICU. And maybe include a few personal things because really that's what keeps a PICU Nurse Practitioner sane...the things outside of work!<br />
<br />
So today I invite you to revisit June. Because really, who doesn't love June!? It's probably my very favorite month of the year! It's the first month that truly feels like summer to me (at least where we live). It's the month I was married in. It's just a great month!<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5XLB24M5t0jPEfkwn09f_cjv748tlrOfJsPoMcsZIwVtVEBuLiNMhE9Xm93w5WRQYakFyaPIZUo7Rx9ilMYHSl34jeC11ueIQ0-ByCkK1xbPlAEHUlrCVHY7MJJhFRXUm4k-zCjoTLyfo/s1600/DSCN3664.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5XLB24M5t0jPEfkwn09f_cjv748tlrOfJsPoMcsZIwVtVEBuLiNMhE9Xm93w5WRQYakFyaPIZUo7Rx9ilMYHSl34jeC11ueIQ0-ByCkK1xbPlAEHUlrCVHY7MJJhFRXUm4k-zCjoTLyfo/s320/DSCN3664.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My mom has been asking for about a year for a picture of me in my lab coat at my desk...so there ya go mom! I absolutely LOVE having my own desk, with my own pictures...and my own phone extension! So much fun!</td></tr>
</tbody></table>
<div style="text-align: center;">
<strong><span style="color: blue; font-family: Georgia, "Times New Roman", serif;">Highlights of June:</span></strong></div>
-Jon and I celebrated our 8th Anniversary on June 4th...hello, am I even OLD enough to be married for 8 years!? What!?<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVWLXfa1OtQRyrXiXxnKOeh3UxvIJWfyn-GR6vVpwFdMAvBXZkRqWqdzKzN9V4n_1l97ygBg-AIgw00XLeDU9Obrs27DlK34R6sQQZWRAxA0dZEECz8aSRWdkUyJugWZ3CcjwW3tpb0wWY/s1600/June+dates+(14).jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVWLXfa1OtQRyrXiXxnKOeh3UxvIJWfyn-GR6vVpwFdMAvBXZkRqWqdzKzN9V4n_1l97ygBg-AIgw00XLeDU9Obrs27DlK34R6sQQZWRAxA0dZEECz8aSRWdkUyJugWZ3CcjwW3tpb0wWY/s200/June+dates+(14).jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mmm, what better anniversary dinner than <br />
lobster tail, scallops and risotto with great wine!</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRUFO9qDacI1XsWZ85y4blDHaPAQizN0GxUyqt5gqPELbCK_VxLCcAefXuYK8gCBjWk0HhmmEGc6FdWKckuPzLqfnLEIXBd88X_RV7IIeSlwDnPArGCIcwrjM8dzJCpl7ksVwcuadoHeKB/s1600/June+dates+(13).jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRUFO9qDacI1XsWZ85y4blDHaPAQizN0GxUyqt5gqPELbCK_VxLCcAefXuYK8gCBjWk0HhmmEGc6FdWKckuPzLqfnLEIXBd88X_RV7IIeSlwDnPArGCIcwrjM8dzJCpl7ksVwcuadoHeKB/s200/June+dates+(13).jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">And what better way to celebrate than in PJs, <br />
no makeup and glasses...classy I tell ya!</td></tr>
</tbody></table>
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div style="text-align: left;">
-I took a couple of days of PTO...just because : ) now that's nice! And it allows time for things like farmers markets, long bike rides, and runs with my hubby who swears he's not a runner...but I'm slowly convincing him otherwise : ) </div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbAlmda-ZtIxK6BSq12n-zOerPna7kbjbEyMurbEqKe_kFLLbgRtE-_tIpsDS-CXBr4SVHfqS0Q2gSpQwQz9wRGDlqh9kTCKdgFzKFuF-n06nKjWbnVU_pG8AFUHmJZtjoXj-U3MqJ9DHo/s1600/Farmers+market+&+date+(3).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbAlmda-ZtIxK6BSq12n-zOerPna7kbjbEyMurbEqKe_kFLLbgRtE-_tIpsDS-CXBr4SVHfqS0Q2gSpQwQz9wRGDlqh9kTCKdgFzKFuF-n06nKjWbnVU_pG8AFUHmJZtjoXj-U3MqJ9DHo/s200/Farmers+market+&+date+(3).jpg" width="150" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC4-XyHJNQgM4XQ8pBksjU0_C0HxyIE59eOH0qQEU1d_q5FNjYGUW0y25Xa27zKob_QxSoFtCaQ3N86_z4jQMkqnMt6gRa7oPanusAk-WrTlcn2RtlDMXOCE_pqUHFsPxHiFOM2Gpck81v/s1600/June+dates+(7).jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC4-XyHJNQgM4XQ8pBksjU0_C0HxyIE59eOH0qQEU1d_q5FNjYGUW0y25Xa27zKob_QxSoFtCaQ3N86_z4jQMkqnMt6gRa7oPanusAk-WrTlcn2RtlDMXOCE_pqUHFsPxHiFOM2Gpck81v/s200/June+dates+(7).jpg" width="150" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkSDfvFKPqD_qJ8fO_PrmlPdv4q9-cMTI3A1YUNbW3rOOYU2Z0wVW1OZQPbFpwzvDtVoHg-etj6-AVk0BAsXKKoh_ZG4wpD_wF_Gl4pqm7Mom6csTOOecEBamUgkONLQi7Is4P-UgWo160/s1600/Saturday+in+the+park+(3).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkSDfvFKPqD_qJ8fO_PrmlPdv4q9-cMTI3A1YUNbW3rOOYU2Z0wVW1OZQPbFpwzvDtVoHg-etj6-AVk0BAsXKKoh_ZG4wpD_wF_Gl4pqm7Mom6csTOOecEBamUgkONLQi7Is4P-UgWo160/s200/Saturday+in+the+park+(3).jpg" width="200" /></a></div>
<br />
-I did my first educational session with a group of nurses at a pediatricians office with one of my old co-workers and great friend. While I have always known that I love...LOVE...teaching, this just reinforced it! It was so much fun being able to teach "Pediatric Emergencies" to a group of nurses, through a little bit of lecture and a lot of interactive games, a scavenger hunt, and a cut throat relay! What a great evening!<br />
<br />
-I started precepting...again. This time as a nurse practitioner. I remember after being a nurse for a year and being asked to precept for the first time, I thought "Are you crazy...I've only been a nurse for ONE year!? I'm not smart enough to precept!!" And this time around as a nurse practitioner I thought "Boo ya, I got this!' BA HA HAAAAA...NOT!!!! I actually thought the exact same thing as the first time around! But it turned out to be a good experience...one in which the orientee and I both learned a lot! And once again reinforced how much I love teaching.<br />
<br />
-And June ended on a very dirty note. Literally. At least this time it was dirty mud outside of work...and not the many types of "dirty" that the PICU can (and has!) bring!<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4uqYdSIwmxkCdBPoWTeOfyRxOxmqT8D5YifmauIaNrp89OA0-Hs6VWTIfBKz-r_HTP5mUj2Co2rnP-uqOAmNpuUl8N9SYtcVxnL6D2OkA6_9FDbXilOyfUL9hq9ogg3TUbpbr94BDji8I/s1600/DSC_0236.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4uqYdSIwmxkCdBPoWTeOfyRxOxmqT8D5YifmauIaNrp89OA0-Hs6VWTIfBKz-r_HTP5mUj2Co2rnP-uqOAmNpuUl8N9SYtcVxnL6D2OkA6_9FDbXilOyfUL9hq9ogg3TUbpbr94BDji8I/s200/DSC_0236.JPG" width="131" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnjKOaP4NajFrye71N7R9JKjnOJ0w_Qzlhr29_mkdBSd5rvmSDMNsjDvqjkIkFu0aFztCvLJOBhDS-DlYqroXHsWa5mrlsD5c1gUleDxgPCxJ9Lz0TYcRgY4kAJytTRpfJkJPRj_XoKuIS/s1600/20130629_105458.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnjKOaP4NajFrye71N7R9JKjnOJ0w_Qzlhr29_mkdBSd5rvmSDMNsjDvqjkIkFu0aFztCvLJOBhDS-DlYqroXHsWa5mrlsD5c1gUleDxgPCxJ9Lz0TYcRgY4kAJytTRpfJkJPRj_XoKuIS/s200/20130629_105458.jpg" width="150" /></a><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIYW9FBdnPQ2rAMDCPNMg5IrRhKSxr6OlJkaRr8KAGxD-o4SPfVbqBOM1tEgSRCqt-yjMwWQACl10zZXxkyEXDhNRMaUASvzQtci1OdPA6F5J5T-lj6pn8ZpZy8uOENs3mQJQWZ_6oBh6g/s1600/20130629_113259.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIYW9FBdnPQ2rAMDCPNMg5IrRhKSxr6OlJkaRr8KAGxD-o4SPfVbqBOM1tEgSRCqt-yjMwWQACl10zZXxkyEXDhNRMaUASvzQtci1OdPA6F5J5T-lj6pn8ZpZy8uOENs3mQJQWZ_6oBh6g/s200/20130629_113259.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A few befores..while we were still clean : )</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjffg2mIp0PwJ8UIC5h7d9bIMCsg-bLiyJZhOYS6ytY2Y9o455poB3aIbkQnUH96A62rwE0GalGTJ5AlhwBZvgO625IHwrXhnax-nIjKz241A7wrJd9S-Gc2idwSahQC7h-4op1M4IBxPIF/s1600/20130629_134327.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjffg2mIp0PwJ8UIC5h7d9bIMCsg-bLiyJZhOYS6ytY2Y9o455poB3aIbkQnUH96A62rwE0GalGTJ5AlhwBZvgO625IHwrXhnax-nIjKz241A7wrJd9S-Gc2idwSahQC7h-4op1M4IBxPIF/s320/20130629_134327.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">And after...just a little dirty : ) Stef and I have been besties since I was born. Meg and I besties since, well highschool...and frenemies for 6 years before that : ) Oh the memories we've made, and are still making! I love it!<br />
<br />
<strong><span style="font-family: Georgia, "Times New Roman", serif; font-size: small;">So that was my June. How was yours??</span></strong></td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
</div>
Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com3tag:blogger.com,1999:blog-1902698416871808828.post-48516794128921534932013-08-28T10:26:00.003-05:002013-08-28T10:26:52.738-05:00ICU PsychosisICU Psychosis is a very real thing. I see patients with it all of the time.<br />
<br />
And I think that I've had it the entire summer. That's why I haven't blogged since May!<br />
<br />
OK, that's most likely not the reason I haven't been blogging. In actuality I think there are a lot of reasons. My differential diagnosis (if you will : ) includes but is not limited to:<br />
<br />
1.) It's summer...who wants to stay inside and stare at a computer when you can be outdoors and enjoy the short lasting sunshine!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3s-YqSFFifVd6bRClKA8dKt5yYbw9dT7LYh9aLEBfmLJfyVQz0r5nJXlIAM1_EspLSoyE-WfsQ1-R5bq-dpSSu4nhCiRsFn01Oj9lt7Hd-rK1nVxJr_DNKbLluNJVk6L9Xn7oTkE2tc8s/s1600/20130519_133629edited.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3s-YqSFFifVd6bRClKA8dKt5yYbw9dT7LYh9aLEBfmLJfyVQz0r5nJXlIAM1_EspLSoyE-WfsQ1-R5bq-dpSSu4nhCiRsFn01Oj9lt7Hd-rK1nVxJr_DNKbLluNJVk6L9Xn7oTkE2tc8s/s200/20130519_133629edited.jpg" width="200" /></a></div>
2.) The amount of night shifts I'm required to do increased starting at the beginning of summer, and I feel like lately a majority of my job is spent on nights and weekends....YUCK! If I blogged about that, you'd be depressed. Because it makes me that way. And I may scare away some new grads or students who want to go into the PICU.<br />
<br />
3.) There's just a lot going on, both in worklife and real life. And some has been fun and exciting, and others more emotional and challenging. And since I'm not one to process emotions very quickly or easily, it's best I figure that out before it spews on a page for the world to see : ) <br />
<br />
But I'm back. I started this blog as a way to document the many adventures that I had as a nurse, and now as a nurse practitioner. And I want to continue to do so. I want to retire one day, and be able to look back at the many fun and sometimes funny memories that life in the PICU brings. And even the not so fun, or downright sad memories are important because they have helped shape me into the Nurse Practitioner I am today. <br />
<br />
So I enter the (almost) fall with a renewed energy in work, in life, and in blogging. Thanks for sticking with me during my hiatus. And to the sweet reader "Anonymous" who commented back in July to make sure I was ok...thank you! Yes, I'm ok. <br />
<br />
I'm better than ok. And I have A LOT to catch you all up on. But rather than cramming it into one blog (because that would really turn into a mini-novel, and nobody wants that!), I will try to get you updated i<br />
n short spurts. <br />
<br />
So as I leave you today, all I can say is buckle up because it has been, and will continue to be, one bumpy, crazy, and most definitely adventure-filled ride on this road I call being a PICU Nurse Practitioner.Danahttp://www.blogger.com/profile/00591958643405410364noreply@blogger.com6