Tuesday, October 29, 2013

Three Things Thursday...ahem, Tuesday

3 Things I'm Loving:
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???

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!

3.) The pickles I wanted to try here...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!

3 Things I'm Loathing:
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. 
image via
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!?
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!

Monday, October 21, 2013

Psychic in the PICU

Lately, I think I'm psychic. 

And I know what you're thinking.  Because I thought it too.  I'd see commercials for psychics and roll my eyes. 

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.

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. 

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. 

The patient was 4 years old, new onset diabetic, in DKA.


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. 

Lo and behold, an hour later, guess what type of patient I admitted!?  An 8 year old in status asthmaticus.

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!). 

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. 

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!

What the what!?!?

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!

You may call me psychic.  You may call me crazy.  You may call me lucky.  

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! 

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!?

What would you read about if you knew it would come to pass shortly after???

Thursday, October 17, 2013

Three Things Thursday

In 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:

3 Things Thursday

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!).

And thats ok because really, a nurse is not just a nurse.  There's a whole other life once she (or he) leaves the doors of that hospital.

So enough introduction.

Here's the first installment of Loving & Loathing 3 Things Thursday!

1.) Peaceful, quiet moments in the morning with my homemade pumpkin lattes, great books, and a chocolate hazelnut candle!

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!

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!!

sorry for the bad picture quality....camera phone not at its finest!
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!)

courtesy of
courtesy of
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!
*So you can't feel the cold...but can you see it in the grey skies!?*
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!

Monday, October 14, 2013

PICU Call Rants #1 and 2

RANT #1:

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.

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.

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.

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!

Rant 1 over...phew! Although it will lead me into Rant #2....

RANT #2:

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.


I was supposed to call it what it "was"- "Call shift."  Why??? Because that's what the medical model called it.

OK, there's some crazy, slightly ironic reasoning if I've ever heard it! 

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 nursing connotation would be appropriate! 

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!)???

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. 

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. 

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.

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!

Thursday, October 10, 2013

Turning PICU dislike into like...or even love!

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.

Ever happened to you??

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)!

Grr, I hate when that happens.

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!

Either way, life happens, it gets in the way.  Moving on.

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.

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! 

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.

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!

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.

But I've decided that the more procedures I get to do, and the better I get at them, the more I enjoy them. 

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. 

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.

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.

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???