Thursday, November 22, 2012

Giving Thanks

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

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

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

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

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

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

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

Being able to take day                       trips...

...and long weekend trips
Long weekend Carribean cruise

 ...and unbelievable full out vacations!

Skiing in Colorado

Maui and Kauai


San Francisco...

                                                                              and San Diego

and of course:
-best friends
-holding sweet little babies
-homemade creamer and a hot cup of coffee in a favorite mug
-reading in the morning with a great smelling candle
-laughing with Jonny
-holding hands
-my most cozy, fuzzy slippers
-stretch pants that can be dressed up or lazily worn around the house (yes, I am TRULY grateful for these!)
-enjoying a glass of red wine
-getting in a good hard workout
-cooking dates with my man
-and of course, my family!

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

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

Happy Thanksgiving 2012!

Saturday, November 17, 2012

Questions Answered

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday, November 13, 2012

Lumbar Puncture

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

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

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

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

Schooling to become an APN is great for some aspects, but certainly not great in getting in procedures.  So this was the lovely that I got to practice an LP on:
Nice, right? And oh so lifelike!  Especially because the manequin that I was working on failed to actually have vertebrae..not that those are important for anything other than being the very cornerstone of placing the needle!

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

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

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

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

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

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

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

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

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

Friday, November 9, 2012

Assertive APN

Yup- it was as bad as I thought!

Parts of it were actually worse.

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

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

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

The OR could not be any different than the PICU.

And it certainly isn't for me!

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

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

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

This speech got me tons of different comments ranging from:

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

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

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

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

Gee, thanks guys!

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

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

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

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

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

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

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

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

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

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

All in the name of the PICU.  Booyah!

Sunday, November 4, 2012

Back in the OR

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

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

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

So, moving on.

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

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

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

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

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

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

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

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

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

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

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

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