Change(?) Of Heart

In my typically obsessive brain, I’ve been mulling over this capstone issue for days now. I know it’s not the end-all, be-all of my future in nursing, but I really want to look at my options and my experiences realistically, and choose the area I really want (rather than the area I think I want or that I want to want). Does that make any sense?

One of the things I’m realizing about my peds rotation is that I am having so much fun! But I’m having fun holding babies and cuddling little ones. I’m NOT having fun doing the “nursey” stuff when it comes to kids…physical assessments are harder, you can’t really have stimulating conversations with a 9-day old, and med administration terrifies me because they’re so small and vulnerable. So it makes me wonder, do I love my rotation because I love kids or because I love NURSING kids? The two don’t always go hand-in-hand, and at this point I’m beginning to doubt myself.

One of my rotation buddies was telling me that our clinical instructor could tell my friend was a pediatric nurse at heart because the interventions she listed on her care plan were so kid-focused. She came up with ideas that would never have occurred to me. Not that this makes me bad at peds nursing, but maybe my brain isn’t wired that way. The realities of peds nursing are such that I wonder whether I could do it 36 hours a week…

Which is a scary feeling, because peds nursing is where I ALWAYS pictured myself. It’s a little disconcerting to start questioning something you were so sure about. But as a friend pointed out today, at least I’m realizing it now rather than once I’m actually working and have signed a contract.

One thing I do know is that oncology is where I want to start. Whether that’s with the kiddos or the grown-ups is what remains to be seen. I had an amazing time shadowing on the Onc floor during my Med/Surg rotation last spring, and after my own personal experiences, I know what an extraordinary difference oncology nurses can make to their patients (and have heard the same thing from others who’ve battled the beast). So perhaps I’ll start there, and stay open to working with cancer patients of ALL ages at one point or another.

Oh, Nurse Teeny. Give the turning wheels a break for once!!!

Rollin’, Rollin’, Rollin’

It was another awesome day on the infant/toddler unit! For most of the shift I helped care for a one-month old with rule out sepsis, a four-month old with pulmonary hypertension, and a four-year old with surgical repair of a myelomeningocele that had been interfering with her bladder function. They were all adorable…and my little girl was so much fun. She was a huge Dora the Explorer fan, and I just happened to have some Dora stickers in my pocket. Boy was that one of the smartest purchases I have ever made!

Then in the afternoon we got a transfer from the peds ICU…wouldn’t you know it, he was a nine-day old little cutie pie with transposition of the great arteries (TGA). My brother was also born with TGA and was one of the first kids to undergo an arterial switch operation at Boston Children’s Hospital 21 years ago. Back then, the procedure was experimental and done only by a few noted cardiothoracic surgeons. My kiddo today had his surgery last week in our hospital and it sounded as if it was fairly routine (as routine as one can be, switching the pulmonary artery and aorta back to their intended location). It’s amazing how far medical technology can take us…

In post-conference this evening, my classmates and I got to practice blood draws and IV starts. I had never done it before, not even on a plastic arm in the learning lab, so I was really nervous. Luckily my partner had veins like tree trunks and he was an easy stick. I did go too far on the IV start and went through the vein rather than into it, but I was pretty excited that I got 1 out of 2. I’m also relieved just to have had the experience…it’s a lot easier not to have your first venipuncture on an innocent little baby! Unfortunately, my partner had a little more trouble…my veins are notorious for being nearly impossible to get. Anesthesiologists, experienced phlebotomists and IV therapy nurses alike have all complained about my access. I’m one of those sticks that require blind faith and a little luck. Today D made a valiant effort and was very gentle, but those veins just kept movin’ away. I told him if he ever wanted to try his hand again, he was welcome to come at me with a needle.

Halfway through our Peds rotation already!?!? Time sure does fly when you’re having fun!

CAP-ping It All Off

The countdown toward 75% nurse-hood is here, folks! We officially have only four more weeks of classes before summer semester is finito. How in the world that happened so fast is beyond me…

With the approach of our final semester (before the NCLEX at least) have come many frantic conversations regarding our “Capstone.” Also known as practicum, senior internship, call it what you will, it is the culmination of our student clinical experience. It is a place to try something we haven’t had exposure to before, or to spend more intensive time in a specialty we think we want. Often it leads to a job offer (although the economy has resulted in hiring freezes at many local hospitals, causing many in the cohort ahead of us to receive verbal offers that were later retracted). Basically we are assigned a preceptor and we work whatever our preceptor works…days, nights, weekends, whatever, we get a little taste of life as an RN. 180 hours’ worth of a taste. It is our primary commitment this fall, besides our nursing leadership seminar and a review class to prepare for the NCLEX.

Word on the street is that we’ll be meeting with the faculty in charge of placements within the next few weeks, to learn exactly how this process works. But in the meantime, all kinds of rumors are flying… What if we want a placement that isn’t set up yet – is it possible to find a preceptor ourselves? What if there’s a lot of competition for a particular kind of placement…how do they decide? For example, do you really need to get a top score on the Pediatrics ATI in order to get a Peds placement? Is GPA a factor? Do we need letters of recommendation? We’re all kind of feeling each other out, to see who else among us might want what we want. And trying to figure out how hard to fight for our own preferences.

What I do know is that we have to give them a list of 3-4 places we’d really like to be, and they make every effort to get us somewhere on that list. So now begins Nurse Teeny’s typically obsessive mental anguishing over how to rank her preferences. I love peds, that much is true. And I love oncology. So obviously Option #1 will be Peds Hematology/Oncology.

While it would be a dream come true for that to work out, it’s also not the end of the world if I DON’T get my first choice (who knows if there’s even a spot available?). But where does that lead me? Do I request a peds placement anywhere because it would get me a step closer to a job in pediatrics (or try to get into peds cardiology)? Or do I request an oncology placement so that I become an expert in cancer care and then move into peds at some point in the future? Like I’ve said before, I ended up really liking adult nursing, so I wouldn’t be heartbroken to do adult oncology. It’s cathartic in a way, to care for people like my dad and make a difference in their lives the way his nurses did for us. I’ve heard again and again from current and former cancer patients that oncology nurses are a breed unto themselves. It would be an honor to give back.

Or there’s the option of a hospice placement…I know that I want to do hospice/palliative care nursing, preferably in home health and preferably with kids. But do I really want to start there? Would it not be better to get some exposure to hospital nursing, so I know where people who end up in hospice have been? Would that sort of placement limit job opportunities because I would have fewer hours in an acute care setting?

I know that there’s nothing I can do about it for now so I should probably just take a chill pill, but it’s getting so close and we’re talking about it more and more. These are the questions that keep me up at night…

Love Me Some Lil’ Tykes

Oh my goodness, I am IN LOVE with pediatric nursing!  After last week with three teenagers, I was thinking “Meh, this isn’t so different from Med-Surg, do I really need to specialize in peds?”  Don’t get me wrong, I had a great time with the adolescents but it didn’t really give me a picture of children’s nursing.

But after today on the infant/toddler unit, I can honestly say that this is where I belong.  There is something about working with these kiddos that just makes my day.  No matter how sick they are, or how much they cry, I just love every minute of it.  I admit that I was a little nervous about having the really little patients, because, well, they’re little.  I didn’t want to make a scary mistake when they seem so much more vulnerable!  But my primary patient today was a month-old angel who was in to rule out sepsis.  His mother was with him throughout the day, but when she needed a break, I got to hold him and cuddle him and sing to him.  There is something miraculous about the tiny ones (and of course it fueled my own baby fever even more).  The other patients I helped were a toddler with croup and a six-year old post-op following a T & A (tonsillectomy & adenoidectomy).  The toddler was ADORABLE…when I took out her IV, she clapped and smiled at me.  The six-year old was a sweetheart too, and his mom was also a nurse, so she was super helpful.

So it was an affirming day…I don’t necessarily feel that I have to work with the really young ones, but I do know that peds is for me!  Bring on Week #3!

Jury’s Out

So I watched the series premiere of HawthoRNe last night on TNT. I had high hopes for the show because my general impression of TNT dramas is very positive. The Closer is one of my favorites and it definitely redeems the rest of the crap on summertime television.

Anyway, my overall impression of Episode 1? Meh.

HawthoRNe stars Jada Pinkett Smith (also the show’s executive producer) as the chief nursing officer at a hospital. The series opens on the one-year anniversary of her husband’s death, as she unsuccessfully tries to convince said husband’s best friend (and a cancer patient) from jumping off the hospital rooftop. After that dramatic beginning, the next thing you see is one of the staff nurses given a little “extra TLC” to a patient. Ugh…

I’ve been waiting a long time to see a drama that accurately portrays the work that nurses do. I rolled my eyes when “13″ (a diagnostic medicine fellow) inserted a Foley catheter on House, and think the amount of time the Grey’s Anatomy surgeons spend providing patient-centered care is totally unrealistic. Even ER, which may be my favorite medical drama of all time, has the doctors doing a lot of the work that the nurses really do (although at least some of their main characters are RNs). So when I heard that three … count ‘em, three … shows will be focused on the life and work of nurses this year, I was thrilled. However, I am really disappointed in the premise behind Showtime’s Nurse Jackie…a Percocet snorting, doctor-boinking mess who deserves a smack for the way she talks to patients (at least according to the previews I’ve seen). We’ll see if NBC does a better job with Mercy as a mid-season opener in 2009-10.

I know that in order to write a drama, the script has to be dramatic. Duh. But for people who don’t really understand what nurses do, beyond what they see on television, I wish there was a way to really capture who we are. But maybe that’s impossible. Maybe I should just stop taking it too seriously, and enjoy the shows for what they are…fiction. I know nursing is the most trusted profession in the U.S., and I know the difference that nurses can make. I just want to show the world what we really do for people!

HawthoRNe definitely has promise. Smith’s character is complex, intelligent and a strong advocate for her staff and her patients. She might just be the show’s saving grace. The first episode also explores the whole doctor-nurse conflict issue, about which I also had mixed feelings. A nurse questioned a doctor’s insulin orders but ultimately administered the prescribed dose and almost killed the patient. That definitely has the potential to happen, but most nurses I know would seek additional guidance if they had genuine qualms about an order. And the doctor who wrote the mistaken order was just over the top b*tchy…again, it probably happens and the show did balance her characters with more helpful and friendly doctors, but I’ve never seen an MD throw such a tantrum!

Many of the other cast members portray rather stereotypical characters…the perky nurse who gets puked on and remains perky, the somewhat jaded charge nurse (at least I think she was a charge nurse), and the token male nurse. Hopefully with future episodes, they’ll be able to add some substance to their characterizations. If not, even Smith’s excellent acting may not be enough to save the show.

So no verdict yet. I’ll keep watching for now.

Pukey Adolescents, The Sequel

Day 1 of pediatrics came and went, and thanks to an awesome nurse who allowed me to follow her around like a puppy dog, I had a wonderful time.  I started learning the ropes of a new hospital system (having had all of my previous rotations through a different conglomeration), including electronic charting, medication administration, communication with other health care providers, etc.  I got to watch the IV team put in a PICC line. And I ended up caring for three (I repeat, THREE) teenagers!  Welcome back to my adolescent psych rotation.

In actuality, they were all sweethearts.  Even the one with a ‘tude.  One had run her ATV off the road and landed in a stream, resulting in a head injury, liver and kidney lacerations, dislocated hip, and fractured cervical vertebrae.  She’s lucky to be alive.  The second had fallen off a tractor and cut his foot and leg severely (not to mention breaking his toe).  The final patient had a ruptured appendix and was in the hospital to initiate IV antibiotics – she was the one with a PICC line because she was going to need IV access for several weeks until her surgery.  The new protocol for a ruptured appendix is not to remove it right away, but instead to blast the patient with IV antibiotics and encapsulate the infection, then to remove the infected appendix several weeks later.  It’s much less messy, and there’s a reduced risk of spreading the infectious material that has spilled into the peritoneal cavity and causing sepsis.

I actually really enjoyed interacting with my patients – maybe it’s my own history of being rather “pukey” myself during those years – but I feel in my element and hopeful that I can be someone they can trust.

Next week I get to be on the infant/toddler unit and play with the babies!  And my clinical instructor tells me that there’s a very real possibility I’ll be able to work with some oncology patients towards the end of my rotation.  They’ve actually broken ground on a fancy new 7-story children’s hospital to expand their pediatric services (scheduled to be completed in about three years…right when I graduate, how convenient!).  Seven stories = lots of jobs! And the best part is that even though they don’t have enough kids with cancer to build a dedicated oncology floor, they’ll be combining hem/onc with cardiology to create one unit!  So I’d get to do cancer treatment and cardiac care if I worked there!  Only my perfect job..

Nurse Teeny’s Boot Camp

Some of you who have read this blog for a while or have glanced at my other blog know that 2008 was the year of the “Healthy Teeny”.  After years of watching the scales tip dangerously and my previously awesome curves balloon out like nobody’s business, I decided that enough was enough and started a journey toward a more healthy lifestyle (having gallstones didn’t hurt as a motivating factor either).  It wasn’t easy, but I also had a lot of support…I was living at home where everyone else ate healthy, my mom had bought me personal training sessions for my birthday and Christmas, and the entire focus of my life was on healing after such a trying 2007.  So taking care of myself became part of the healing process.  And I lost over 40 pounds!

Then came nursing school.  Not that I’ve gained it all back and not that I really have any excuses, but the change in lifestyle, the move to a new environment, and the emotional and intellectual roller coaster of my educational experience have all taken their toll on my previously health-centered mindset.  Ironic, isn’t it, that nurses often take excellent care of others, but leave their own well-being far behind?

I’m the type of person who relies on food to cope, and I’m also the type of person to say “Oh, I blew it, so I’ll start again on Monday.” Five pounds and several fatty meals later, I’m so frustrated with myself by Monday that I come up with another excuse to delay what I know needs to be inevitable.  But am I really that “type” of person or is that who I believe myself to be, because it’s easier in some way to think I don’t have it in me?  So I’ve decided to own the setback, stop punishing myself with more unhealthy choices, and get back on track.

The big kicker came this week when my best friend moved her wedding date up by two months – she’s getting married next year and I’m a maid of honor.  I know she loves me whatever size I come in, but I was kind of looking to her wedding date as my motivation to get my butt back to the gym.  But I was also piddling around because I knew the wedding wasn’t until next July.  13 months no more, Nurse Teeny, now the wedding is in less than a year!!  But I also know that there are many other reasons I need to do this: for my own wedding to come in the (hopefully) near future, to make future pregnancies easier, to make 12-hour shifts a little less hard on the feet, and most importantly, to model for my patients and for myself what it means to be healthy.

So in the interest of accountability, I thought I’d share my idea for a workout schedule with you all (based on our “typical” class schedule that will commence next week, as our clinicals kick off).  Not that you really care , but if someone else knows what I’m supposed to be doing, I’m apt to avoid the embarrassment of not following through:

• Monday: Class from 10 am – 4 pm with a one-hour lunch break.  Walk dogs, pilates and/or strength training in the morning before school, 30 minutes of cardio during lunch break at school gym.
• Tuesday: Class from 1 pm – 4 pm.  Walk dogs, Zumba cardio at home in the morning
• Wednesday: Class from 1 pm – 4 pm.  Walk dogs, strength straining and yoga at home in the morning
• Thursday: No class (hooray!).  Walk dogs, Zumba toning at home
• Friday: Clinical Shift. 12 hours on my feet will suffice, thankyouverymuch.
• Saturday: Late morning water aerobics at local community center
• Sunday: Late morning dance class at local community center

5-6 days a week should help do the trick.  The food part is harder because of my history of emotional/stress eating.  If folks have suggestions for how to work on that, I welcome your comments, public or private.

Oh, and I give you all my blessing to nag me about this as much as you want… I don’t want to make this blog about weight loss or dieting – there are plenty of other websites out there – but I notice how poorly we nurses can take care of ourselves and it lights a fire under my bum to be part of the solution, not the problem.

Farewell, Healthy Teeny ‘08.  Hello, Healthy Teeny for Life!

Waxing Poetic

Today in my Family Nursing class we shared “bio-poems” with each other about someone we knew or had met at a 12-step meeting who struggled with addiction (or was related to someone who did).  Bio-poems follow a specific formula to reflect important dimensions of a person’s life…our professor encouraged to think about how we might use this as a tool for a more in-depth look at the families we encounter.  ‘Probably wouldn’t have time to do this on a Med-Surg unit, but for more long-term processes, it could be really helpful to use bio-poems about each family member in order to help each person understand what is most important to, most feared and needed by their loved ones.  It might also be helpful in our future capacities as Clinical Nurse Leaders, both as a team-building exercise for the nurses with whom we work and as a family-building exercise if we choose to focus our leadership efforts on encouraging family-centered nursing.

She also encouraged us to think about our own bio-poems…what would they say and how might they change as our roles transition from nursing student, to novice, to CNL, to experienced nurse?  So I thought I’d try my hand at it, and write new bio-poems throughout this journey, at significant mileposts.

Here goes Round 1…

Nurse Teeny

Hard-working and passionate, helpful, an open book

Daughter of soul mates, big sister

Lover of family, dogs, and a guy named “S”

Who feels optimistic, curious, and often tired

Who needs to be challenged and loved, and to be a nurse

Who fears loss: loss of love, loss of contact, loss of hope

Who gives compassion, knowledge, and a healing presence

Who would like to be a wife and mother, and never stop learning

Resident of the Ivory Tower

Nurse Teeny