Yeah!

Finally, this semester is really, really over! Passed my final exam with flying colors and am now ready to finish the last 15 weeks of the program. I cannot begin to tell you just exactly how excited I am to be that much closer to my degree :)) Graduation day is May 15 and coming up soon! *pats self on back for a job well done!*

last class!!

Finally! Our last class of the semester was today. Too bad I was too tired to enjoy it. Our final tests are on Monday with finals on Thursday :) I am soooo happy to finally be done. Now just one more semester before graduation and I cannot even begin to relate the load that is slowly coming off of my back. Woot! :))

Hoping to have more time to post some stories and stuff and get this blog completely updated over break. See you very soon. Gonna be a busy weekend with work and studying :)

goodness, time just flies by

well we finished our fall break without incident, for sure. just have one more test this semester, ati, and then our final exam. i am so excited to be just almost finished with just one more long semester to go. unfortunately it is going to be filled with nothing but med-surg, and i have already been forewarned of just how difficult it is. i just want to be done, but moving ahead slowly but surely. this semester has seemed to just simply fly by. i can remember our first clinical in the psych hospital, and now of course, we are finished with clinicals for this semester. having gone through all of the OB stuff has been really exciting. it will be difficult to go back to the other stuff and have to relearn and review it all over again in even more detail than before.

work has still been crazy with the census fluctuating from shift to shift it seems. we have been blessed with warmer than normal weather lately and people just aren't really sick yet. i have a feeling that when they finally do succumb, we will be getting slammed. i am ready for all the learning experience i can get in the icu over this winter and spring so that when i graduate, i am ready to work. i will probably have to work on the floor to begin with, but i still hold out the possibility of working in the unit when i graduate. that is why they are spending the time with me to work in there, because that is where they are planning for me to work if there is a spot open.

A break!

well finally we have reached our fall break (or thanksgiving break really). i am so excited not to have to look at anything for a whole week... well if that were exactly true it would be nice. we will have our second peds test when we come back, so i plan on reviewing so i don't have to cram it all in at the last minute. i hate cramming for a test. 3 more weeks before our final exam an then a glorious 15 weeks left of school before i graduate. i am getting so burned out on studying that the day cannot come soon enough for me. unfortunately, i am scheduled to work for most of my break, so no real vacation for me. it would be nice, but my kids want to play youth basketball, so have to earn the money for that! :)

Random Ramblings

I am so happy to be almost finished with OB. We have our last lecture on it today with our testing on Monday. Not that it wasn't a fun and interesting rotation. I actually loved it. But it is another milestone conquered in the happenings of nursing school. We are left with Peds for the rest of the semester, and I am so very thankful to have completed that clinical rotation. We all know that caring for sick children can be very demanding. In fact, it is probably the parents that can make the experience even more difficult. I just know that I am not cut out to be a Peds nurse at all, ever.

Census is still down at the hospital, so it seems on the weekends anyhow. Or at least there haven't been too darn many critical patients. In a good, perfect world, that is really is a GOOD thing, right? But man does it ever make my paycheck stink. I need people to be sick enough to be in the ICU so that I can work and learn, don't they know this? It is times like this when I wish that I would have just stayed out on the floor instead of being a little hot shot and transferring over to the unit. I know I made the right decision for myself, just perhaps not my paycheck. I love working in the unit though, and I wouldn't trade the experience for the world.

What do you say to a fellow student who thinks that she is the know all to everthing, talks over you in clinicals, interrupts when the instructor is asking questions to answer the question that was asked of you? Do you just let her go on and make a fool of herself because she doesn't know when to shut up? What do you tell her when you are going to do some patient education, and it is her wish to follow you, knowing when she gets in there, she will take over and mark it down as her accomplishment? Well I let her talk over me in front of the instructor so that the instructor could see what she was doing, but when it came to my patient, I politely told her, "I think I am going to do this one by myself, thanks." Yeah, it pissed her off pretty good. She won't talk to me, heck she won't even barely look at me. I don't see how this is my problem anymore :) I know she is sensitive to matters like that, and I am sure that she took it personally when I said I wanted to deal with my patient by myself, but that is what we are supposed to do! I certainly didn't follow her into her room and interrupt her whole educational session with her patient. I know she just wanted everyone around to know that she knows everything. Well, now she can go bother someone else because I am sure she won't bother me anymore.

have to run to class in a few to get our last OB lecture. ciao.

a mini vacation...

census is down and i did not have to work ALL weekend long. i cannot even begin to tell you just exactly how much i needed these days off to recover from lost sleep and whatnot. it was beautiful. really. so did i get to work on the project due at the end of the month? nope. did i review my study notes from the lectures? nope. haven't cracked a book or looked at anything to do with nursing in 3 whole days. i feel like a new person though! i feel like i might actually be able to concentrate in class tomorrow. i am refreshed. renewed. ready to finish out the rest of the semester. i try not to think of next semester when we have med-surg II. i have heard the horror stories. i have heard just exactly how hard it is. i don't want to go back to hard, but i don't have a choice, do i? although i am more comfortable with the knowledge that we get with med-surg. it is more focused upon the stuff we will really see in the hospital. i love ob and i love the newborns, but in my area, there is no hope for a job there. those people just never leave. they stay in that unit for years and years and years. i will have to move if i have ob aspirations. even in the icu, the same goes for in there as well. another unit where people aren't inclined to leave or even transfer out. i will have to move if i plan on having a job in that area. although there is one possibility of a person leaving, i just have to hope that they hold out til may or close to it. but i will probably have to chose the med-surg/tele mixed floor where the unit director wants me to start until they have an icu position open up. i want options! i want to make the decision for myself. i don't want to feel pushed into accepting a position that i might not want. sure i still have several months before this arrives, but they are already discussing it, without me, of course. and still, people ask my opinion, where do i want to work when i graduate? i always answer the same and tell them that i don't know. i don't know what will be open when i do. somewhere in there, they aren't getting the options message. i suppose i just need to lay it out for them and tell them that i don't want to commit yet. that this is a decision i need to make on my own. will they listen? nah. i doubt it. all they see is a potential person to fill that open slot on nights. sigh. i know new grads often have to work nights because days gets the more experienced nurses. i even don't mind working nights. but that is still them making the decision for me. i will figure it out. soon.

been awhile...

well it has been awhile since I have had the time to update. I didn't imagine that it would take quite this long for me to get back into the swing of things, but it has. This semester in school has really taken a toll, and it is supposed to be the easiest semester out of them all. I might disagree. Although the subject matter might be a little easier, we have had projects out of the wazoo to do which takes up a good amount of time.

Our Psych rotation came and went without an ordeal. I wish that we would have been able to have our clinicals at an acute Psych facility, but on the other hand, I am glad for the bit of experience that we did get. It was enough for me to know that is so not the field that I want to go into at all! Now we have started OB and Pediatrics. I have finished my Peds rotation, thank goodness. Another field that I know I do not want to go into. :) Not that there is anything wrong with kids, but it is just not my thing. I have had the opportunity to work a few more shifts up in the OB unit at work along with my clinical experience, and I do still really enjoy that. I don't know if that is what I want to do or if I want to stick with the hopes of being in the ICU. It will all depend upon what is open when I graduate. But I love, love newborn babies! In addition to the hospital clinicals this semester, we also have to do clinicals in the health department and in two schools. I dunno what I think of that yet as mine do not come up until November.

That's all I have right now for a little update. Nothing really significant or exciting has happened lately. Census has been down a bit at the hospital, as is expected, but I know things will pick up soon with the colder weather moving in.

DNI

We had a lady in the unit who was loved by her family. They were not quite ready to let her go. In fact, they requested that everything be done for her, except intubation. Unfortunately, she was in respiratory failure. So overnight, her sats began to go from the 90's on a bipap machine to the 80's, then to the 60's and so on. Her fingers were purple, but she had a strong pulse generated by her pacemaker. The daughter was called in because it was obvious that we would have to code this lady. The charge nurse pulled the crash cart into the room and RT was called. Once they had the ambu-bag set up, CPR was started. Drugs were pushed. Her BP came up from the epi push. She had agonal breathing, and unfortunately the efforts to keep her alive without intubation failed. The family came in the room to say their final goodbyes, and she passed on quietly.

I had a hard time understanding why the family wanted CPR but not intubation when the patient was in obvious respiratory failure. I don't know if it was a lack of understanding of the procedures, but generally in this situation, intubation is probably the only thing that would have kept her alive, but she would never have come off of it. Perhaps that is what they were told, and thus the decision not to have intubation. But CPR on a respiratory failure? Did the doctor not fully explain? How come there aren't booklets or pamphlets that will explain this to families and patients, in terms that they can understand? Maybe there are, but I have not seen them. People have spent so much time watching patients miraculously saved on tv shows, and this just isn't reflective of what really happens. When the body is in multi-organ failure, time is minimal and probably not even CPR or intubation will be able to save the person, only prolong the inevitable.

If I were a politically active person, I would be all for pushing for the patient's right to be comfortable in the end. I also believe that if doctors were there on the floors having to care for these patients like nurses do, so many more things would be done to provide comfort measures at the end of life. Especially for DNR patients. I guess I will end my rant here... I understand that ethics is a major player in the above situations for everyone involved. Just sometimes it can be frustrating to watch a person suffer.

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On a different note, I get to fully transfer to the ICU as an extern in September. I am so excited!! I have spent the last 6 months out on the med-surg floor, and I am ready for some new areas to explore. I plan on spending the rest of the summer trying to learn the rhythms and ekg's. I have already learned a little bit, but not nearly enough! Though I can pick out a PVC, not that is too difficult really. I just need more experience, plus learning how to recognize the different lead views etc that is shown on the monitor. I am even thinking of purchasing a book to study up on it. It's not that I don't have a ton of things to already finish the rest of the summer. I have to finish my project for the fall. Have a great idea for that. I also need to go down to the school and finish some computer modules that are due this fall as well. Am doing great in my pharm class... our final is coming up soon. Otherwise, have a wonderful rest of July. I am taking a break from blogging unless something fantastic happens in the meantime before school begins.

it's a girl!

I finally got to go to OB for the first time last night. What a refreshing experience!! And to go there and find a lady about to give birth. Since we are starting on our OB/Maternal-Neonatal rotation in the fall, I jumped on the experience as soon as I found out. It took 2 hours of grueling pushing to finally get the baby out.. a whopping 9 lbs! And her first baby... but it was so beautiful. Beautiful in the sense that a new life has joined the world and beautiful in that it was so nice to see healthy young people instead of our normal elderly patients on the regular floor. I really love to work in the unit, but I really enjoyed working with the moms and babies as well. I do hope I get to do it again sometime in the future. I am up way past my bedtime, but will add more to the story later when I can get my thoughts completely together. :)

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On another note.. my youngest son's baseball team won their first All-Star game yesterday. Congrats to all of the boys on the team and hoping for another win tonight in the tournament!
Unfortunately, they lost the next two games and were defeated :( I am so proud of my son for his outstanding performance though. It is really something when the coach of the other team comes up to tell him what a good ballplayer he is :))

A Final Goodbye

Tonight one of our long term patients passed away. He had been there right around a month, so we all knew him and his family quite well. At the 4 am rounds, nothing seemed to be out of sorts. Vitals were good. A half an hour later, the son comes out of the room and says that there was some blood around his IV site. I went in to have a look as my preceptor was taping her report. I didn't see anything that was unusual. Sometimes blood comes back with a flush, which had just been done a bit earlier. The son was worried he might be in some pain, so I gently asked the patient, who was not very verbal, to try to squeeze my hand. This was to see if he could follow commands. He squeezed my hand several times. So I asked him to give a good tight squeeze if he was in pain, but he did not differ in how he squeezed. I told the son that sometimes about 3 or 4 in the morning he would wake up for about 30 min to an hour and have a spell where get got a little out of sorts, but it usually passed. The son left the room for a few minutes, and I decided to wet a cool wash cloth and hold it on his forehead for a minute. I wiped his face off and the edge of his hair. Lifted up his non-rebreather mask and wiped his face under it. I could tell that this had a great calming effect on him. I held his hand and told him that he was a special man who had family that loved him very much, that they had been here with him every day. I began to notice a change in his breathing, so I watched closely for a minute. I knew that it was time. I zipped out to the hall to get my preceptor, whom I could hear at the nurse's station and told her to move it in there. She came in and a had a quick look and took off to get the son. I told the patient that his son was just outside and he would like to say goodbye before he left us for good. I told him everything was okay; he was not alone. He looked at me for a moment and shut his eyes. The son came in a bit confused, and I told him that his father was about to pass on. He immediately began to tell his father what a pleasure it was to be his son, that he was proud of him and to go be with his mother. His father took 3 more breaths before he left this world. I told the son to keep talking because hearing was the last thing to go, that it meant a lot to be able to tell someone you love them and to say goodbye. The son was amazing. I hoped that my children would do the same for me when it is my time to pass on. A few minutes later, my preceptor comes back in, checks for heart sounds. I told her there had been no respirations for about 5 minutes now. She told the son then that his father had for sure passed on. And he finally cried. And so did we. I always wondered how I would handle such a death, now I know. I am proud of myself for being there with the patient so he did not have to be alone. I am just thankful that he is suffering no longer. May he rest in peace at last.