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!?

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

Three Things Thursday

In an effort to improve my consistency in blogging (because I really do enjoy it, and particularly enjoy reading things from a year and 2 years ago!), I have decided to start what I will call:

3 Things Thursday

So every Thursday (or as many as I can remember!) I will present 3 Things that I love from the week, and 3 things that I loathe from the week.  It may or may not pertain to the PICU. Some days there is just nothing to love within the confines of those walls.  And other days there's nothing to loathe (LOVE those days!).

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

So enough introduction.

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

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!!


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

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!)


courtesy of

courtesy of

2.) The cold we weather that came through today and looks like it's here to stay..BRR!  I was SO loving the warmish fall we have been having here. Guess it had to end some time!

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

 

3.) Politics in general...it's just not my thing. But what's really getting me this week is the exorbitant amount of it that keeps inundating my favorite tv shows and the internet! I know I should be a little more up to date with some of the things going on, but really!? Can't we all get along! Obviously not!



courtesy of

PICU Call Rants #1 and 2

RANT #1:

First of all, let me start this post with saying how much I hate saying "call shifts."  In the PICU, I am not "on call." I am present, for the entire shift.

I am not able to sit at home, on my couch, or sleep in my bed, and simply answer a phone to give a nice quick answer to the nurse calling about a patient.

I am there, in the PICU, generally running around, barely getting to sit down, sometimes not getting dinner, and many times not drinking enough water to produce adequte urine output.

I wish we'd just call it night shift. Because really, that's what it is.  Well, a combination afternoon and night shift.  But either way, that sounds better than "Call shift"....because that's NOT what it is!

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

RANT #2:

The REASON why we don't call it night shift!  I had a manager tell me in the last several months that calling it night shift (AKA: I hate working nights!  Night shift sucks!...sorry that's generally how the phrase comes up from me) referred to bedside nursing.

Huh?? 

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

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

First of all, I AM a nurse!  I may be an Advanced Practice Nurse, but I am a NURSE!  So calling it a night shift, which could have a nursing connotation would be appropriate! 

Second of all, I did not go to medical school. I am not a physician.  So do I really care if I am following the medical model, or using medical terminology (no, not at work, but in situations such as this!)???

I'm realizing more and more lately that being an APN is a weird chasm between two worlds.  We are not quite nurses anymore, but we are not quite physicians either.  I function exactly the same as the fellow physicians in the PICU, and yet I'm not a fellow.  I have nursing in my title, and was a great bedside nurse for 8 years, but no longer function in that way. 

And I take great pride in being a nurse.  Families and patients call me doctor all the time, and I very quickly correct them. Not because I feel I'm not "worthy," but more because I know that patients and families see a big difference between the care that they get from me and my fellow APNs vs some of the residents or other physicians.  And I want them to continue to differentiate the two. 

What a weird chasm to be in- in one world, but a part of another.  But as weird as it in, and as with all things nursing and APN related, I know that I will figure it out.  Figure out how to be an incredible APN in a medical model while still holding tight to the values and traits that are exclusive to nursing. figure out how to continue to differentiate ourselves as APNs from the physicians.

But most importantly, figure out how to get everyone else on board on calling a cat a cat, a dog a dog, and a night shift a night shift!

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

So apparently I'm a stinky blogger lately.  I really had great intentions to get right back to it, and chronicle all of the adventures lately, but then life just happens.

Ever happened to you??

You know, you create a "To Do" list with expectations that come the end of the week, the month, whatever, and all your items will be checked off.  And then that time period ends, and you have one check mark (if you're lucky)!

Grr, I hate when that happens.

And no, I'm not saying that writing my blog is a burden or even ever on my To Do list.  Although I think if I put it there, I might have an improved writing rate!

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

The PICU has been crazy busy lately.  Like CRAZY busy!  We not only have a high census, but we have a higher acuity than we have in a long while.  And this generally happens in the winter with summer time being a bit slower, but it's happened earlier than I remember it in past years.

That translates to staying late for a lot of shifts.  Coming home and wanting to just collapse on the couch only to have notes still to write.  And call shifts that turn 16 hour nights into 18 or more without sitting down, eating much, and barely peeing.  Yeah, that can't be good for ya! 

We've seen a TON of meningitis lately.  I've gotten to do 3 LPs in the last 2 weeks because of it.  It's definitely been a great time to be able to get more procedures for sure.  And I'm liking procedures more and more.

Someone asked me several months ago if I "loved procedures!?!!?"  To which I really had to answer, "Umm, sure, I guess." It's not that I dislike them.  I just couldn't say that I "LOVED" them!

I think it's mostly because we don't get procedures all that often in my institution because there are several APNs on one shift, working with a fellow.  Anytime we're on call or day shifts with first year fellows, they get priority in procedures.  Or if a second or third year "needs" more of whatever procedure, they get priority over us as well.  Plus, we let intervential radiology put in a lot of our central access, so that drastically decreases the amount of lines getting placed in the PICU.

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

I guess that's probably true with many things.  I don't enjoy bowling, but it's b/c I'm pretty lousy.  On the other hand, I love soccer, ping pong, volleyball, etc.  But I'm also pretty good at that. 

So I guess if we're going to be insanely busy in the PICU with crazy sick kids, I'll relish in the fact that its an opportunity for me to get more procedures.  And for me to get much better at them!  Which in turn, will most likely increase how much I enjoy doing them.

Unless its placing chest tubes...b/c I just hate that!!!  Even if I were a chest tube pro...ugh, that's the one thing that just grosses me out.  But that's a different story for a different day.

What's something that you are learning to love, or like a little more, as you get better at it?  Could be in nursing school, as an APN, or just in real life???

July in the PICU

July was a big month for me in regards to my career in the PICU.

I didn't work for 2 whole weeks!! 

And while that sounds counterintuitive as to how that could be huge for my career, it truly was.  Because while I wasn't physically working in the PICU, I was working in Prague, Czech Republic.

That's right...July was the BIG Noise Study Poster Presentation at the Sigma Theta Tau International Nursing Research Conference. I'm not going to say too much about it in this July recap because I will have a whole post on it, but it was an incredible experience!

I was able to meet a lot of great people, from a lot of different countries.  I was able to get my feet wet with poster presenting.  And hello, I was able to go to Prague!

After Prague, Jon and I headed off to Italy where we were able to spend about 2 days in Rome, and a week in Cinque Terre.  We stayed for 3 nights in Vernazza, and 3 nights in Monterosso.  All I have to say about Cinque Terre now is if you haven't been, you MUST go.  It needs to be on everyone's top 3 places to visit before you die list!

 

Outside of traveling, there were some other highlights of July.  But let's not kid ourselves...nothing that could compare to Prague and Italy!

 

We started the month by spending a relaxing 4th on a rooftop in the city with some good friends, a once in a lifetime view of fireworks from about 45 towns all at once  (unless of course, we go there next year!), an amazing homemade rubarb pie, and a few glasses of good wine. Now that's a good 4th to me!

I then went on the next week to participate in the 4th Annual Critical Care Bootcamp.  It was my second time participating, and let me tell ya it was about 1000 times better this year!  Myself and one of my co-workers who started about a year before me were initially signed up to learn how to be instructors for upcoming years, but we were signed up too late. So we went as participants.  And while we were both initially dreading it, it was actually a fabulous learning experience.

As uncomfortable as Simulation Labs can be (who wants to pseudo-take care of a manequin that talks to you while the rest of the class is watching you through the one way mirror!), they take you so far outside your comfort zone that you truly remember those lessons! 

And it was also very exciting to see how far I've come in the last year.  I've grown in my confidence, in my knowledge, and in my patient care overall.  Since the rest of the group were brand new APNs and fellows, for the first time ever, I actually felt like I had a bit of a leg up.  It was a short, small...very small, leg, but I'll take it.  That never happens, so yes, I relished in it just a bit : ) 

So there ya have it.  PICU in July.  You know, a little bit of Bootcamp, a little bit of holiday partying, and oh a little trip to Europe!!

 

What crazy, fun, memory making things did you do in July???

The PICU in June

I figured since I'm so behind on my blogging, I'd do a few summer recaps on the PICU. And maybe include a few personal things because really that's what keeps a PICU Nurse Practitioner sane...the things outside of work!

So today I invite you to revisit June.  Because really, who doesn't love June!?  It's probably my very favorite month of the year!  It's the first month that truly feels like summer to me (at least where we live).  It's the month I was married in.  It's just a great month!

My mom has been asking for about a year for a picture of me in my lab coat at my desk...so there ya go mom!  I absolutely LOVE having my own desk, with my own pictures...and my own phone extension! So much fun!

Highlights of June:

-Jon and I celebrated our 8th Anniversary on June 4th...hello, am I even OLD enough to be married for 8 years!? What!?

Mmm, what better anniversary dinner than
lobster tail, scallops and risotto with great wine!

And what better way to celebrate than in PJs,
no makeup and glasses...classy I tell ya!

 

 

 

-I took a couple of days of PTO...just because : ) now that's nice! And it allows time for things like farmers markets, long bike rides, and runs with my hubby who swears he's not a runner...but I'm slowly convincing him otherwise : ) 

-I did my first educational session with a group of nurses at a pediatricians office with one of my old co-workers and great friend.  While I have always known that I love...LOVE...teaching, this just reinforced it!  It was so much fun being able to teach "Pediatric Emergencies" to a group of nurses, through a little bit of lecture and a lot of interactive games, a scavenger hunt, and a cut throat relay! What a great evening!

-I started precepting...again.  This time as a nurse practitioner.  I remember after being a nurse for a year and being asked to precept for the first time, I thought "Are you crazy...I've only been a nurse for ONE year!? I'm not smart enough to precept!!"  And this time around as a nurse practitioner I thought "Boo ya, I got this!'  BA HA HAAAAA...NOT!!!! I actually thought the exact same thing as the first time around! But it turned out to be a good experience...one in which the orientee and I both learned a lot! And once again reinforced how much I love teaching.

-And June ended on a very dirty note.  Literally.  At least this time it was dirty mud outside of work...and not the many types of "dirty" that the PICU can (and has!) bring!

A few befores..while we were still clean : )

And after...just a little dirty : ) Stef and I have been besties since I was born.  Meg and I besties since, well highschool...and frenemies for 6 years before that : )  Oh the memories we've made, and are still making! I love it!

So that was my June.   How was yours??

 

ICU Psychosis

ICU Psychosis is a very real thing.  I see patients with it all of the time.

And I think that I've had it the entire summer.  That's why I haven't blogged since May!

OK, that's most likely not the reason I haven't been blogging.  In actuality I think there are a lot of reasons.  My differential diagnosis (if you will : ) includes but is not limited to:

1.) It's summer...who wants to stay inside and stare at a computer when you can be outdoors and enjoy the short lasting sunshine!

2.) The amount of night shifts I'm required to do increased starting at the beginning of summer, and I feel like lately a majority of my job is spent on nights and weekends....YUCK! If I blogged about that, you'd be depressed.  Because it makes me that way. And I may scare away some new grads or students who want to go into the PICU.

3.) There's just a lot going on, both in worklife and real life.  And some has been fun and exciting, and others more emotional and challenging.  And since I'm not one to process emotions very quickly or easily, it's best I figure that out before it spews on a page for the world to see : ) 

But I'm back.  I started this blog as a way to document the many adventures that I had as a nurse, and now as a nurse practitioner.  And I want to continue to do so.  I want to retire one day, and be able to look back at the many fun and sometimes funny memories that life in the PICU brings.  And even the not so fun, or downright sad memories are important because they have helped shape me into the Nurse Practitioner I am today. 

So I enter the (almost) fall with a renewed energy in work, in life, and in blogging.  Thanks for sticking with me during my hiatus.  And to the sweet reader "Anonymous" who commented back in July to make sure I was ok...thank you!  Yes, I'm ok. 

I'm better than ok.  And I have A LOT to catch you all up on.  But rather than cramming it into one blog (because that would really turn into a mini-novel, and nobody wants that!), I will try to get you updated i
n short spurts. 

So as I leave you today, all I can say is buckle up because it has been, and will continue to be, one bumpy, crazy, and most definitely adventure-filled ride on this road I call being a PICU Nurse Practitioner.