Holy Moly! I am back in the work force. Well, I'm technically not back yet. 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.
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.
Let me back up a bit though because it's been awhile!
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.
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.
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!
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!
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.
Not a tall order for a nurse practitioner at all, huh!?
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.
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.
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.
BUT it wasn't!!
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.
BUT it wasn't!!
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.
BUT once again, it wasn't!!
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!
Honestly, it seemed to good to be true. Some days, despite a contract, it still seems too good to be true.
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.
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.
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!).
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!
But I also know that I am a fast learner, and am willing to take whatever challenge lays ahead of me.
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!
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!
Here we gooooooo.............................................................
Sunday, September 25, 2016
Thursday, July 9, 2015
A PICU-less Update!
Well, well, and suddenly 6 months have flown by since my last post! Seriously how does that even happen!?
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 : )
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.
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.
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.
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!?.
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.
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!"
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!?
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.
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.
So strike 3, I'm out : )
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....
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.
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.
So I continue to be a PICU nurse practitioner...at heart, at home : )
It's definitely not the life turns that I would have expected for myself, but I am truly happy.
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.
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).
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!
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 : )
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.
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.
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.
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!?.
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.
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!"
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!?
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.
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.
So strike 3, I'm out : )
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....
I found out I was pregnant!!!
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.
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.
So I continue to be a PICU nurse practitioner...at heart, at home : )
It's definitely not the life turns that I would have expected for myself, but I am truly happy.
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.
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).
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!
Saturday, January 24, 2015
Measures of Success
Well 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.
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.
What I have thought about, however, is how much my definition of success has changed in the last 7 months since becoming a mom.
In the PICU, a successful day was going home at a decent hour with my patient(s) still alive.
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.
But I am thinking that this is where the similarities probably end.
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.
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!
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.
A really successful Mom day includes a 20 minute dedicated work out.
A successful PICU day involves completing rounds, all procedures, multiple patient examinations, charting, and all phone calls before 6 pm.
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. *Let me tell ya, we don't have many successful solid eating days around here!*
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.
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 one 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.
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.
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.
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.
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.
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!
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.
What I have thought about, however, is how much my definition of success has changed in the last 7 months since becoming a mom.
In the PICU, a successful day was going home at a decent hour with my patient(s) still alive.
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.
But I am thinking that this is where the similarities probably end.
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.
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!
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.
A really successful Mom day includes a 20 minute dedicated work out.
A successful PICU day involves completing rounds, all procedures, multiple patient examinations, charting, and all phone calls before 6 pm.
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. *Let me tell ya, we don't have many successful solid eating days around here!*
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.
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 one 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.
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.
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.
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.
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.
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!
Sunday, December 14, 2014
PICU APN?
Isn't it amazing how fast time just flies by when you are having fun!? Since I last blogged (7 1/2 months ago!!!) I was placed on modified bedrest at 34 weeks, had a beautiful baby girl, moved to Lawrenceville GA, then moved to Suwanee GA. Whew!
So here I am, 2 1/2 months after my maternity leave technically ended, and am no longer a PICU APN. Well, that's not entirely true. I will always be a PICU APN at heart. But I am no longer employed by a PICU as an APN.
For the time being, I am enjoying being at home with my baby girl. My original plan once we got down to GA was to get another job by the time Isabella was 6 months old. Well, she is now 6 months, and I haven't even put my application in.
Part of this just makes total sense to me. And part of it still surprises me how happy I am being at home with her. I have always said that I did not want to be a stay at home mom. I am passionate about what I do. I thrive in the PICU setting. I do well staying busy and on my toes.
And certainly staying at home can be busy too. Just a completely and utterly different kind of busy.
Staying at home has taught me the importance of slowing down and enjoying the little moments. It has taught me that rocking my baby through the pain of teething, or just simple fussiness is as important as what I do in the PICU.
It has taught me that while 12 hour days flew by in the PICU without question, 12 hour days at home can too...except I don't have the same work to show for it. It's amazing how little can be done with a new baby, and yet that can easily be classified under a successful day!
And so here I am in work limbo. I am still not entirely sure where the next path will lead me in my career.
My plan is to enjoy the holidays with my family, and not worry or think once about a new job. In a career that is 24/7, holidays not excluded, this is a great change of pace.
Once the new year comes, I will take a look at what is out there. What I do know is that I would love a PICU position. What I know more than that however is my family comes first. That means I want something part time, and something where I can be home in the evenings and not a total mama monster, so no night shifts!
I have no idea what is out there. I have no idea if it will take me one day, one month, one year, to find the next best thing for me. What I do know is that it will be very weird for me to say anything other than "PICU APN" when someone asks what I do. And it will be slightly heartbreaking at first.
But, with new priorities come new challenges and new adventures. So I look forward to where that may take me!
But first, I will enjoy the peace and togetherness of the holidays. I hope that you take some time to slow down and enjoy this time with your family and friends as well! I will see you next year!
So here I am, 2 1/2 months after my maternity leave technically ended, and am no longer a PICU APN. Well, that's not entirely true. I will always be a PICU APN at heart. But I am no longer employed by a PICU as an APN.
For the time being, I am enjoying being at home with my baby girl. My original plan once we got down to GA was to get another job by the time Isabella was 6 months old. Well, she is now 6 months, and I haven't even put my application in.
Part of this just makes total sense to me. And part of it still surprises me how happy I am being at home with her. I have always said that I did not want to be a stay at home mom. I am passionate about what I do. I thrive in the PICU setting. I do well staying busy and on my toes.
 |
| With all this cuteness, who couldn't love staying at home! |
Staying at home has taught me the importance of slowing down and enjoying the little moments. It has taught me that rocking my baby through the pain of teething, or just simple fussiness is as important as what I do in the PICU.
It has taught me that while 12 hour days flew by in the PICU without question, 12 hour days at home can too...except I don't have the same work to show for it. It's amazing how little can be done with a new baby, and yet that can easily be classified under a successful day!
And so here I am in work limbo. I am still not entirely sure where the next path will lead me in my career.
My plan is to enjoy the holidays with my family, and not worry or think once about a new job. In a career that is 24/7, holidays not excluded, this is a great change of pace.
Once the new year comes, I will take a look at what is out there. What I do know is that I would love a PICU position. What I know more than that however is my family comes first. That means I want something part time, and something where I can be home in the evenings and not a total mama monster, so no night shifts!
I have no idea what is out there. I have no idea if it will take me one day, one month, one year, to find the next best thing for me. What I do know is that it will be very weird for me to say anything other than "PICU APN" when someone asks what I do. And it will be slightly heartbreaking at first.
But, with new priorities come new challenges and new adventures. So I look forward to where that may take me!
But first, I will enjoy the peace and togetherness of the holidays. I hope that you take some time to slow down and enjoy this time with your family and friends as well! I will see you next year!
Tuesday, April 22, 2014
PICU Midyear Review
It's April which means time for the annual Midyear Review. It's a time to check in with the manager, go over the goals we set 6 months ago to make sure we're on target for reaching them, and evaluate what we are doing well vs what we can improve.
I've worked in the same PICU for the last 9 years, and really have never had much feedback in the "what we can do to improve" area.
This year, we have a new manager who strongly believes that at least one area for improvement needs to be focused on. So I knew after talking with several other APNs who already had their review that there would be some legit personality feedback.
That being said, I had NO idea what to expect going in. And let's just say when I left, I left with a smile on my face.
Not because I didn't have something to work on. But because what I had to work on was something not surprising to me...and because of the way that it was presented.
So as my manager started saying "The top area for improvement is"...she had a smile on her face. She then proceeded to say "I would work on your patience...particularly with the newer fellows."
Now a fairly recent conflict came to mind in which I was extremely frustrated with a fellow who did not act in the best interest of the patient, and didn't follow the plan that we had set out the day before. Let's just say I walked in that morning fiery and let him know it.
So I asked if this area of improvement...patience...was based on that particular incident. My manager said "Oh, absolutely not...that situation was 100% called for and the way you handled it was filled with passion for the patient, and a bit of impatience was very appropriate to fight for what was right!"
So when I asked for examples, she simply stated that at times I come up with a plan for my patients, and if the fellow isn't "on my level" I can get impatient with them waiting for them to get there.
I'm not entirely sure what that meant (or rather, couldn't think of specific examples), but I definitely realize that I can certainly work on patience in general.
She then proceeded to say that while she can tell that I am impatient at times because she knows me so well, other physicians that provided anonymous feedback were surprised to hear this because I come across and "joyful and pleasant".
We then moved on to the "Additional comments" section and I just had to laugh out loud. What in the world does "takes no prisoners" mean!?!?
She laughed and said that a physician gave that feedback and said that I was a very hard worker, and would do whatever it takes to get the best care for my patients...taking no prisoners along the way. *I'm definitely thinking this was referring to the above incident, that afterwards was fully supported by the APN manager, PICU director, and Critical Care medical director...yes, it was a rather large situation which is why I was so firey!*
So in a way, the impatience is tied in with taking no prisoners.
As a PICU APN, I love my job. And I love caring for patients and their families. I want what's best for them mind, body and soul, and yes I will fight to make sure that happens. So if a little bit of impatience can help to get that done, I'm ok with that.
However, I know there are areas that I can grow in. Focusing on areas of my impatience that can have a negative impact on myself and my co-workers is one of them. I want to be a team member that people enjoy coming to work to see. Someone who lights up the PICU that can be a dark place at times. Someone who can admit to their flaws, and change them, or work on turning them into a positive.
At the end of the day, it was another good PICU Midyear Review. Probably the best review that I've ever had because it actually gave me something to work on, on top of giving me a ton of encouragement. And while I will definitely work on my patience, I have no plans on "taking less prisoners"....because really, how awesome does that sound!?!?
I've worked in the same PICU for the last 9 years, and really have never had much feedback in the "what we can do to improve" area.
This year, we have a new manager who strongly believes that at least one area for improvement needs to be focused on. So I knew after talking with several other APNs who already had their review that there would be some legit personality feedback.
That being said, I had NO idea what to expect going in. And let's just say when I left, I left with a smile on my face.
Not because I didn't have something to work on. But because what I had to work on was something not surprising to me...and because of the way that it was presented.
Now a fairly recent conflict came to mind in which I was extremely frustrated with a fellow who did not act in the best interest of the patient, and didn't follow the plan that we had set out the day before. Let's just say I walked in that morning fiery and let him know it.
So I asked if this area of improvement...patience...was based on that particular incident. My manager said "Oh, absolutely not...that situation was 100% called for and the way you handled it was filled with passion for the patient, and a bit of impatience was very appropriate to fight for what was right!"
So when I asked for examples, she simply stated that at times I come up with a plan for my patients, and if the fellow isn't "on my level" I can get impatient with them waiting for them to get there.
I'm not entirely sure what that meant (or rather, couldn't think of specific examples), but I definitely realize that I can certainly work on patience in general.
She then proceeded to say that while she can tell that I am impatient at times because she knows me so well, other physicians that provided anonymous feedback were surprised to hear this because I come across and "joyful and pleasant".
We then moved on to the "Additional comments" section and I just had to laugh out loud. What in the world does "takes no prisoners" mean!?!?
She laughed and said that a physician gave that feedback and said that I was a very hard worker, and would do whatever it takes to get the best care for my patients...taking no prisoners along the way. *I'm definitely thinking this was referring to the above incident, that afterwards was fully supported by the APN manager, PICU director, and Critical Care medical director...yes, it was a rather large situation which is why I was so firey!*
So in a way, the impatience is tied in with taking no prisoners.
As a PICU APN, I love my job. And I love caring for patients and their families. I want what's best for them mind, body and soul, and yes I will fight to make sure that happens. So if a little bit of impatience can help to get that done, I'm ok with that.
However, I know there are areas that I can grow in. Focusing on areas of my impatience that can have a negative impact on myself and my co-workers is one of them. I want to be a team member that people enjoy coming to work to see. Someone who lights up the PICU that can be a dark place at times. Someone who can admit to their flaws, and change them, or work on turning them into a positive.
At the end of the day, it was another good PICU Midyear Review. Probably the best review that I've ever had because it actually gave me something to work on, on top of giving me a ton of encouragement. And while I will definitely work on my patience, I have no plans on "taking less prisoners"....because really, how awesome does that sound!?!?
PICU APN...taking no prisoners!
Thursday, April 3, 2014
Rounding in the PICU
PICU Rounds are a big part of the day. It's the time when the APN's can present their patient, summarize what is going on, and then state their plan of care for the day.
Usually I love rounding. It lets me take responsibility for my patients. It calls me to think more about them. And it definitely teaches me a lot.
The other day, I learned a big lesson. As I was presenting my patient, I got to the summary part, and said something to the effect of: "This patient remains critically ill, has pulmonary and kidney injury consistent with Wegener's disease..." and went on.
Only to find out later in the day that it is now considered a faux pas to call it Wegener's anymore. Apparently Mr. Wegener was a Nazi, and that just doesn't sit right. Instead, it's now called Granulomatosis with polyangitis.
So there ya have it. You learn something new in the PICU everyday. This APN certainly learned that she doesn't want to be supporting Nazi's or diseases named after them. I will definitely not forget that one!
Usually I love rounding. It lets me take responsibility for my patients. It calls me to think more about them. And it definitely teaches me a lot.
The other day, I learned a big lesson. As I was presenting my patient, I got to the summary part, and said something to the effect of: "This patient remains critically ill, has pulmonary and kidney injury consistent with Wegener's disease..." and went on.
Only to find out later in the day that it is now considered a faux pas to call it Wegener's anymore. Apparently Mr. Wegener was a Nazi, and that just doesn't sit right. Instead, it's now called Granulomatosis with polyangitis.
So there ya have it. You learn something new in the PICU everyday. This APN certainly learned that she doesn't want to be supporting Nazi's or diseases named after them. I will definitely not forget that one!
Monday, February 24, 2014
Only One
I have taken care of a lot of kids in the PICU over the last 9 years.
And yet only one has truly captured my full heart.
Only one who I was able to see grow up from a six month tiny baby to a four year old man-sized boy.
Only one who I spent countless hours with, took countless walks with, and made countless PICU memories with.
One who helped me fall in love with Dr Seuss books, largely because of the ear to ear smiles that would spread over his face as I tripped over my words.
One who taught me every word backwards and forwards to Mickey Mouse Clubhouse and certain Sponge Bob episodes.
One who never got tired of my silly rendition of Itsy, Bitsy Spider.
One who taught me just what it means to be a patient advocate, and one that I advocated just like he was my own son.
One who would smile at very few people as they walked into his room, but I was lucky enough to be one of those few.
One who cried as I left at the end of my shift on multiple occasions.
One who has filled my Nursing Box with more photos, drawings, and cards than any other patient.
One who helped to instill a true, deep passion for the PICU in me.
One who I am now mourning for.
Heaven truly has gained an extra special angel this weekend.
While it was much too soon for you to be taken, and I wish for just one more longer lasting good-bye where I give you kisses all over your face as you roll your eyes, I know that this life cannot offer you what you will have in Heaven.
You have thrown off your cumbersome body brace and are running through the streets of heaven. You have removed your trach and are able to breath freely and easily. Your voice and precious giggle can now be heard once again.
Know sweet boy, that you are loved. Know that you are cherished. Know that you are etched in our hearts. And know that you are so deeply and so dearly missed.
Rest in peace little one.
And yet only one has truly captured my full heart.
Only one who I was able to see grow up from a six month tiny baby to a four year old man-sized boy.
Only one who I spent countless hours with, took countless walks with, and made countless PICU memories with.
One who helped me fall in love with Dr Seuss books, largely because of the ear to ear smiles that would spread over his face as I tripped over my words.
One who taught me every word backwards and forwards to Mickey Mouse Clubhouse and certain Sponge Bob episodes.
One who never got tired of my silly rendition of Itsy, Bitsy Spider.
One who taught me just what it means to be a patient advocate, and one that I advocated just like he was my own son.
One who would smile at very few people as they walked into his room, but I was lucky enough to be one of those few.
One who cried as I left at the end of my shift on multiple occasions.
One who has filled my Nursing Box with more photos, drawings, and cards than any other patient.
One who helped to instill a true, deep passion for the PICU in me.
One who I am now mourning for.
Heaven truly has gained an extra special angel this weekend.
While it was much too soon for you to be taken, and I wish for just one more longer lasting good-bye where I give you kisses all over your face as you roll your eyes, I know that this life cannot offer you what you will have in Heaven.
You have thrown off your cumbersome body brace and are running through the streets of heaven. You have removed your trach and are able to breath freely and easily. Your voice and precious giggle can now be heard once again.
Know sweet boy, that you are loved. Know that you are cherished. Know that you are etched in our hearts. And know that you are so deeply and so dearly missed.
Rest in peace little one.
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Friday, January 31, 2014
"Have You Examined the Patient!?"
Surgeons tend to get a bad rap amongst nurses. Not necessarily in my institution necessarily (or consistently), but in life, in general.
They can be known for bad bedside manners. They can be known for being short (in personality, not stature). They can be known for talking down to all non-surgeon personelle.
And then there are the rare but fine (oh so fine!) moments, when one of them just says something utterly ridiculous that you can call them out on!
What was even sweeter about my interaction with a particular surgeon this week, was there were 3 of my collegues listening in on my phone conversation. As I hung up, they all bust out laughing, and couldn't believe what they had heard.
So enough setting up the story...onto the good stuff!
I had been caring for a four year old girl who had cerebral palsy and several other medical problems. She was severely mentally and physically disabled, was completely non-verbal, can't fix or follow objects, and was definitely on the small side of the growth curve. I know that's a lot of info, but it comes to be important in a bit.
She came in for pneumonia, but I noticed that she was malnourished, and recommended consulting Pediatric Surgery for a G-Tube for feedings. I was actually shocked that up until this point she had been fed by mouth for so long!
Looking through her chart, she had previously had a swallow study showing that she was aspirating (which was just as I suspected), so this further built my case for needing a GT.
I placed the call, told the surgeon why we were consulting, and he said he would go see the patient later in the day and get back to me.
Just as I was getting ready to leave work, I get a phone call. Reluctantly I picked up, and was so glad I did.
The conversation went like this:
Surgeon: "So I went and evaluated your patient. I also talked with the mother for a bit, and we are not going to place a GT. She doesn't need it."
Me: "Umm, I'm sorry, why do you not think that she needs it. She is malnourished, she has a swallow study showing that she aspirates, and given her underlying medical problems, none of this is going to change anytime soon."
Surgeon: "Well the mother says that the patient is able to tell her when she is thirsty, and mom gives her water to drink. She also says when she is hungry and she will get an apple and eat it. She's been doing this for the last four years, and while she may be on the smaller side, perhaps the mother isn't giving her enough nutrition which we can educate her on."
Me: (let me preface that I was BAFFLED at this response!) I simply stated "I understand that you had a conversation with the mother and were given that information, but did you examine the patient!?"
This took him back a bit, and he stumbled over a few words and then said, "Well, yes I saw her."
More adamently I said, "This patient is completely non-verbal...why would we think that she is verbally telling her mother that she is hungry or thirsty!? She is severely contracted and does not have purposeful movements, so why would we think she would say she wants an apple, reach for it, and then feed herself!? I understand what the mother told you, but if you spent five minutes evaluating the actual patient, you would understand the reality very clearly."
*This was the point in which my co-workers were laughing b/c I was so in awe of his ridiculous reasoning that I was definitely firm, but remained very calm*
He didn't particularly like this (I'm assumming), because he got really quiet, then didn't really say too much.
At the end of the conversation, I gently reminded him to go back to the patient, do a thorough evaluation, and then come to a conclusion on whether this child was safe to eat by mouth, and more importantly able to take in the appropriate nutrition that way.
He agreed, and then said that he would talk to his attending and call me in the morning.
The next morning I get a text page from him saying "Discussed with attending. We will place GT in 4 weeks. She will need imaging prior to that."
Short, sweet and to the point.
And yet such a sweet, sweet point made by me!
Just another lesson learned in the importance of truly evaluating your patient. And yes, while parents are a wealth of information most times, sometimes they don't live in a full reality. It takes our medical evaluation, studies, and judgement to help determine what is best for these patients.
Score one for the Nurse Practitioners...lesson learned for the Surgeons!
They can be known for bad bedside manners. They can be known for being short (in personality, not stature). They can be known for talking down to all non-surgeon personelle.
And then there are the rare but fine (oh so fine!) moments, when one of them just says something utterly ridiculous that you can call them out on!
What was even sweeter about my interaction with a particular surgeon this week, was there were 3 of my collegues listening in on my phone conversation. As I hung up, they all bust out laughing, and couldn't believe what they had heard.
So enough setting up the story...onto the good stuff!
I had been caring for a four year old girl who had cerebral palsy and several other medical problems. She was severely mentally and physically disabled, was completely non-verbal, can't fix or follow objects, and was definitely on the small side of the growth curve. I know that's a lot of info, but it comes to be important in a bit.
She came in for pneumonia, but I noticed that she was malnourished, and recommended consulting Pediatric Surgery for a G-Tube for feedings. I was actually shocked that up until this point she had been fed by mouth for so long!
Looking through her chart, she had previously had a swallow study showing that she was aspirating (which was just as I suspected), so this further built my case for needing a GT.
I placed the call, told the surgeon why we were consulting, and he said he would go see the patient later in the day and get back to me.
Just as I was getting ready to leave work, I get a phone call. Reluctantly I picked up, and was so glad I did.
The conversation went like this:
Surgeon: "So I went and evaluated your patient. I also talked with the mother for a bit, and we are not going to place a GT. She doesn't need it."
Me: "Umm, I'm sorry, why do you not think that she needs it. She is malnourished, she has a swallow study showing that she aspirates, and given her underlying medical problems, none of this is going to change anytime soon."
Surgeon: "Well the mother says that the patient is able to tell her when she is thirsty, and mom gives her water to drink. She also says when she is hungry and she will get an apple and eat it. She's been doing this for the last four years, and while she may be on the smaller side, perhaps the mother isn't giving her enough nutrition which we can educate her on."
Me: (let me preface that I was BAFFLED at this response!) I simply stated "I understand that you had a conversation with the mother and were given that information, but did you examine the patient!?"
This took him back a bit, and he stumbled over a few words and then said, "Well, yes I saw her."
More adamently I said, "This patient is completely non-verbal...why would we think that she is verbally telling her mother that she is hungry or thirsty!? She is severely contracted and does not have purposeful movements, so why would we think she would say she wants an apple, reach for it, and then feed herself!? I understand what the mother told you, but if you spent five minutes evaluating the actual patient, you would understand the reality very clearly."
*This was the point in which my co-workers were laughing b/c I was so in awe of his ridiculous reasoning that I was definitely firm, but remained very calm*
He didn't particularly like this (I'm assumming), because he got really quiet, then didn't really say too much.
At the end of the conversation, I gently reminded him to go back to the patient, do a thorough evaluation, and then come to a conclusion on whether this child was safe to eat by mouth, and more importantly able to take in the appropriate nutrition that way.
He agreed, and then said that he would talk to his attending and call me in the morning.
The next morning I get a text page from him saying "Discussed with attending. We will place GT in 4 weeks. She will need imaging prior to that."
Short, sweet and to the point.
And yet such a sweet, sweet point made by me!
Just another lesson learned in the importance of truly evaluating your patient. And yes, while parents are a wealth of information most times, sometimes they don't live in a full reality. It takes our medical evaluation, studies, and judgement to help determine what is best for these patients.
Score one for the Nurse Practitioners...lesson learned for the Surgeons!
Saturday, January 11, 2014
Exhaustion: PICU vs Pregnant!
Hi friends! I know, I know...I've definitely fallen off the blog wagon.
The holidays came and went so fast (don't they always), and now I'm still here thinking now's the time to jump back on.
But then work happens and it's been SO crazy lately! Tons of sick kids equals tons of crazy busy shifts. Which leaves me just flat out exhausted on my days off.
Oh, that and the fact that I'm pregnant!! Really, I think that's the major contributor the extreme exhaustion, but still...the job isn't completely innocent : )
For those of you that personally know me, you know this has been a very long journey to motherhood. Four years of dreaming, planning, praying and hoping. Four years of countless doctor appointments, about a trillion blood draws and medications, and a hormone imbalance and severe clotting disorder diagnosis later, and here we are!!
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So of course I had to start a pregnancy blog that I hope to continue onward and document our little one has he or she grows.
And when I sit down after a really long day in the PICU, I can either get on and blog about how I didn't sit, eat or pee for the last 12 hours, or I can relish in the fact that I'm pregnant and document that amazing journey.
Yeah, guess which one generally wins!?!? (if you're interested: www.littlelerma.blogspot.com)
But regardless, I still love my first blog baby. And I am still madly in love with the PICU. So while I may not be as present, or have as many fun or funny stories, I'm not going anywhere.
Just thought you should know. Because really I know how patient you all are. And since most of my readers are either family or other nurses, I'm grateful that you just get it.
Shoot, my nursing and APN friends probably log on every great once and awhile thinking, "Oh my schedule is so crazy...I don't have time to read blogs!" only to find out, neither does the writer. So at least we are on the same page ; )
I do have some stories in the back of my head that I want to share. And I do have some topics that keep getting asked about (eg: DNP, picking grad schools, studying for boards, etc) that I want to address as well.
So stick with me and we'll get through this crazy, busy life together...one slowly written blog post at a time. And if you're in the PICU like me, you wouldn't want it any other way! What's life without some busy, without some crazy!?!? That's PICU at its finest!
The holidays came and went so fast (don't they always), and now I'm still here thinking now's the time to jump back on.
But then work happens and it's been SO crazy lately! Tons of sick kids equals tons of crazy busy shifts. Which leaves me just flat out exhausted on my days off.
Oh, that and the fact that I'm pregnant!! Really, I think that's the major contributor the extreme exhaustion, but still...the job isn't completely innocent : )
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.
Yeah, guess which one generally wins!?!? (if you're interested: www.littlelerma.blogspot.com)
But regardless, I still love my first blog baby. And I am still madly in love with the PICU. So while I may not be as present, or have as many fun or funny stories, I'm not going anywhere.
Just thought you should know. Because really I know how patient you all are. And since most of my readers are either family or other nurses, I'm grateful that you just get it.
Shoot, my nursing and APN friends probably log on every great once and awhile thinking, "Oh my schedule is so crazy...I don't have time to read blogs!" only to find out, neither does the writer. So at least we are on the same page ; )
I do have some stories in the back of my head that I want to share. And I do have some topics that keep getting asked about (eg: DNP, picking grad schools, studying for boards, etc) that I want to address as well.
So stick with me and we'll get through this crazy, busy life together...one slowly written blog post at a time. And if you're in the PICU like me, you wouldn't want it any other way! What's life without some busy, without some crazy!?!? That's PICU at its finest!
Wednesday, December 25, 2013
Merry Christmas!
Last year I had to work Christmas Eve and Christmas Day, both 12 hours shifts that turned into about 15 each.
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.
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.
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!).
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.
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.
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.
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!
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.
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.
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!).
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.
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.
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.
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!
Thursday, December 19, 2013
Old PICU Friend, New PICU Role
For 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.
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).
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.
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.
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!
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.
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.
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!
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).
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.
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.
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!
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.
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.
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!
Wednesday, December 4, 2013
Customer service at its finest
I love great service. I love giving great service. And I get even more proud when I see great service at work.
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.
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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
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!
Thursday, November 28, 2013
Happy Thanksgiving
Happy 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.
I hope that you all have a safe and blessed Thansksgiving, and year to come!
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!
I hope that you all have a safe and blessed Thansksgiving, and year to come!
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!
Monday, November 18, 2013
When PICU Parents Get in the Way
Ever 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!?
This hasn't happened to me in quite awhile...until last night.
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:
CAT = Critical Assessment Team
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.
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!).
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.
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.
Until last night!
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!
Almost 2 hours later, I was finally ready to leave for home : (
So what took so long for a process that typically takes 15-40 minutes???
The Parents of the Patient! That's what happened!!
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.
My next question was what had been done in the ED and on the floor look into this. The answer? "Weeeeelll.....not much."
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??
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).
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.
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!
Nor did they appreciate that I stated that he really did need an LP. And antibiotics. And once again, they flat out refused.
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 that sick. But he was!!
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.
So here are 2 parts of the PICU that can be hard or frustrating:
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.
and 2.) When parents get in the way of doing what you know needs to be done medically for the patient.
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.
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.
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!
This hasn't happened to me in quite awhile...until last night.
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:
CAT = Critical Assessment Team
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.
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!).
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.
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.
Until last night!
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!
Almost 2 hours later, I was finally ready to leave for home : (
So what took so long for a process that typically takes 15-40 minutes???
The Parents of the Patient! That's what happened!!
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.
My next question was what had been done in the ED and on the floor look into this. The answer? "Weeeeelll.....not much."
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??
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).
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.
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!
Nor did they appreciate that I stated that he really did need an LP. And antibiotics. And once again, they flat out refused.
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 that sick. But he was!!
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.
So here are 2 parts of the PICU that can be hard or frustrating:
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.
and 2.) When parents get in the way of doing what you know needs to be done medically for the patient.
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.
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.
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!
Tuesday, November 12, 2013
PICU Vices
I laugh at how frequently the topic of being a nurse practitioner and alcohol go hand and hand.
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."
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!).
But then I started working as an APN and it definitely took on a whole new meaning. The hematologist APN was right!
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..."
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.
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!
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.
While I was completely joking in asking this question, she sheepishly replied, "Yeah, I've taken up online shopping!"
We both laughed so hard!! Oh boy.
She then replied, "I think I'm going to stick with the wine, because it's definitely cheaper!"
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!
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."
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!).
But then I started working as an APN and it definitely took on a whole new meaning. The hematologist APN was right!
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..."
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.
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!
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.
While I was completely joking in asking this question, she sheepishly replied, "Yeah, I've taken up online shopping!"
We both laughed so hard!! Oh boy.
She then replied, "I think I'm going to stick with the wine, because it's definitely cheaper!"
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!
Are you a wine drinker??? If not, what is your post-nursing/APN hard day vice???
Friday, November 8, 2013
Goodbye Three Things....
OK, after 2 short weeks, and one of them not even being on time, I've decided 3 Things Thursday is over.
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!
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!
So instead, as I come up with them, I can do a 3 things here and there.
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!
So Happy Friday instead! I'm working this weekend and am looking forward to it (as much as you can look forward to working on a weekend!).
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.
My one true career love...days in the ICU!
But tonight, it's a date night in with my man. Nothing can beat that!
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!
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!
So instead, as I come up with them, I can do a 3 things here and there.
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!
So Happy Friday instead! I'm working this weekend and am looking forward to it (as much as you can look forward to working on a weekend!).
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.
My one true career love...days in the ICU!
But tonight, it's a date night in with my man. Nothing can beat that!
What are you doing this weekend???
Friday, November 1, 2013
Happy 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!
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!
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.
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!
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.
HAPPY HALLOWEEN!!!!
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| Horrible lighting, I know...sorry! But we started the night with amazing loaded baked potatoe soup...YUM! |
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| Super excited about carving the pumpkin...and determined not to overcut the top so it falls right in like last year : ) |
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| My spooky dollar store skeletons on our kitchen ledge |
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| 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!) |
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| Ohhhhh....scary! |
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| HAPPY HALLOWEEN!!!!!!! |
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???.JPG)
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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 |
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.
Weird!
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!?
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.
Weird!
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:
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!
LOVING:
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!!
LOATHING:
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!)
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!
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!
LOVING:
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!!
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| 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!)
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| courtesy of |
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| courtesy of |
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| *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!
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