Nurse Teeny is thus far 1/1 in job application success! I had a voice mail awaiting me after class on Friday afternoon, inviting me to interview for the Med-Surg internship! I am beyond thrilled!

The process was not without its share of snafus, however. I got an automated e-mail from the hospital on Monday saying I did not meet their minimum qualifications. As if!

I triple-checked that job description and I was not going to take “No” without a fight.

I think the snag was that the job posting said “BSN required.” I do have a baccalaureate education from my previous degree, but because we already have that undergrad degree, our program skips the BSN. We take the pre-licensure curriculum and become licensed as RNs through a special agreement with the state board nursing, provided we continue our education and get our MSN.

The problem is, one of the questions on the application was “Will you have a BSN by Winter 2009-10?” I had to answer “No” because I won’t, even though I DO have a Bachelor’s degree (cum laude, even!). Since it was an online application, my response was automatically flagged for a rejection.

So when I got my “Thanks but no thanks” message, I immediately e-mailed the nurse recruiter and explained the situation. She made sure I’d be taking the NCLEX in time for the internship and agreed to pull out my application for review. Four days later I got the call for an interview!

The moral of the story is: Persistence pays off! Especially in the era of online applications, it’s important to make a personal connection and be assertive when applying to jobs for which you think you’re qualified. Technicalities can get you flagged for elimination during the first cut, but make sure you do your homework and confirm with a human being.

Next on the agenda…Meet with my capstone unit nurse manager. The stated purpose is to pick her brain about the role of management, but you can bet I’ll be bringing my resume, cover letter and references with me too!

I am officially halfway done with my capstone rotation and decided to commemorate the occasion by working three shifts in a row this week. Man, that is brutal.

It’s interesting how different each shift can be. Day 1 was a little overwhelming (as the first day after a long stretch off can be). Day 2 I felt like I was on the game and could take on the world. I was delegating to my preceptor and assumed almost total care for 2 of our 3 patients. I even had time to take a break!

And I bonded with an adolescent girl with osteosarcoma whose cancer had spread to her lungs. Her family had just decided to change her code status to DNR (Do Not Resuscitate). We were trying to keep her as comfortable as possible. When she found out I was taking my boards in December, she said she’d come back to the hospital and congratulate me. It broke my heart.

Day 3 was hell on earth. For some reason the stars aligned to produce a complete cluster! Our three patients all ended up being more complicated than we had anticipated. A different nurse’s patient had a crazy scary Ativan reaction right before being discharged. Because his nurse was super busy, my preceptor and I ended up helping.

Then we had a chemo spill 30 minutes before change of shift. Luckily it was more of a splatter, but the protocol for cleaning up is quite intense. 15 minutes later, another patient pulled apart his IV line, right as the lab called with critical values that needed to be reported to the resident on duty. His response when I brought the values to him pretty much summed it up: “Sh*t.”

I didn’t get out of there til past 2000 (that’s 8 p.m.). It was the first day I felt like crying because I was so overwhelmed.

But tomorrow is another shift. And I’m ready to go back for more. Just gotta keep pluggin’ along.

Today Nurse Teeny turned 29. One more year as a twentysomething!

To be honest, I won’t miss the twenties. A lot of stuff went down and I’m happy to report that the next decade looks much more promising and full of moments to look forward to. As does the next year!

In honor of my birthday, I applied to my first RN job!!! It is a new grad med-surg internship at a hospital about 45 minutes away, starting in January. There is not really a nursing shortage in my city thanks to an economy in the toilet and the 10+ nursing schools that feed into (read: saturate) the local job market. So they encouraged us to think outside the box and look for positions not in the immediate area or in positions that may not be our first choice but would allow us to build up our skills.

So I did.

There are four specialty areas we can request in the internship: oncology, general medical, general surgical, and surgical telemetry. My first choice was obviously oncology. That was a no brainer! If I can get hired into hem/onc whatever the patients’ ages may be, I’ve got one foot in the door.

I decided to go with surgical telemetry for my second choice. Basically pre-op and post-op patients who are on cardiac monitoring for one reason or another. The heart has always fascinated me! And I’m intrigued by the challenge of learning to read EKG strips really well.

My references are awesome – my advisor/professor who also happens to be our dean (score!), my current preceptor, and the medical director of the free clinic where I used to work. The job posting also did say they’ll give preference to a high GPA, and my grades have been good. So I’m feeling confident that I’m at least as qualified as the next person.

The one thing that makes me nervous is that the position description said “BSN required.” I will be taking the NCLEX in December but I won’t have my BSN because my program skips that step and just gives us an MSN when we finish everything in 2012. I obviously have a baccalaureate education, so hopefully they will take that into consideration. But it made me nervous to answer “No” to the question, “Will I have a BSN by Winter 2009.” Keep your fingers crossed on that little detail!

So there you have it. My first job application as a nurse is in! This is starting to feel very real all the sudden…

The quest for the perfect brain sheet continues…

Following my first few shifts in capstone, I have been continuing to adapt my own time management brain so that it is more-user friendly and attuned to my time management needs on this particular unit.

Some key changes to this latest incarnation, Nurse Teeny’s Brain 3.0:

1. This tool allows for the management of three patients on one sheet of double-sided paper. This works for me because the typical patient load on our floor is 3. I keep a blank copy handy in case of admissions/discharges. Obviously if you have more than 3 patients, you’ll either need two sheets or adapt this to meet your own needs.
2. The far left side of each patient’s “block” includes data such as name, room #, medical record #, age, and sex. The box is big enough in most cases to just place the patient’s sticker there if you prefer.
3. I got rid of the time management 1st page from a previous version. I found that it was cumbersome to have an extra sheet of paper in my pocket, and time-consuming to check for information in two different places.
4. Instead, I incorporated the 12-hour sheduling piece into each patient’s block. For each hour, I can write in scheduled meds/procedures/nursing tasks AND record data that I am unable to chart right away (I&O, vitals, abnormal assessment findings, etc.). Then I check it off once it’s documented in the chart.
5. The pieces of information that are most important to know are on the front side: Diagnosis, code status, current weight (critical in peds), allergies, diet, IV fluids/access, and PRN meds. There is also a little extra box for jotting down notes.
6. I included check boxes to remind myself to do a safety check in each room, check tubing to see if it needs to be changed on my watch, and to encourage oral care and hygiene (both very important in oncology).
7. Lab results go on the back side. I usually only note abnormal or borderline labs in case I need a quick reference. It’s easier than printing out the most recent results and having MORE paper to carry around and fumble with. I also try to indicate which direction the results are going in (up or down), and whether the result is too high or low compared to the reference range.
8. I kept the SBAR section on the backside for each patient. It has helped me tremendously for updating doctors and delivering end-of-shift reports.

The brain can be downloaded in PDF format if you like it the way it is, or in Word (.doc) format if you’d prefer to tweak it for your own needs.

I’ve noticed a lot of traffic on the brain posts, so I’ll continue sharing as long as y’all are finding them helpful…

Happy Time Management!

Sorry to have been so silent lately! I have been absolutely loving my capstone rotation, but these consecutive 12-hour shifts are a killer! I worked three days in a row last week (on my “Fall Break”), and then hopped on a plane early the next morning to spend the rest of the break with family.

So life has been great! I am about halfway through my rotation, which is crazy. By the end of last week, I was taking 2 patients almost completely on my own. Since the max is 3, I feel like that’s progress.

I also had my mid-term eval with my preceptor today and it seems like we’re both very pleased about how this is going. She has hinted numerous times that she would love for me to be hired onto the unit, which would be a dream come true. We’ll just have to wait and see what’s open come December.

I did ask her advice about where I should start if there wasn’t an opening on the floor, which is very possible given the economy and the hiring freezes that many hospitals are in. I mentioned this summer that I would not be opposed to working in adult oncology, but I have continued to be worried that I may not be hired into peds once I’ve started with adults.

My preceptor put those fears to rest, however. She pointed out that I will have completed two peds rotations successfully, which shows my interest in working with the kiddos. She said that if I have a choice, I should make sure I’m working in oncology right out of school. I would be able to become chemo-certified, familiarize myself with the drugs, possibly become certified as an oncology nurse and demonstrate my commitment to family nursing, which is part of cancer care whether your patient is a child or an adult.

Apparently there is at least one nurse on our floor who started with adults and was easily hired into the unit. And with my capstone in peds hem/onc on my resume, she thinks I’d be in prime position. Since I’m perfectly comfortable (even excited) about the idea of working with adults, I’m definitely going to keep my eyes out for those opportunities as well.

It would probably be easier to get hired with adults anyway – there are only two dedicated children’s cancer centers in the state (only one that is part of a larger cancer research center), but there are a number of hospitals within driving distance that provide cancer care to grown-ups. And many places will hire new grads with oncology experience.

It’s refreshing to know that I’m on the right track. Now just gotta make it through that durned NCLEX.

Like now, for example! (Especially when I make my first attempt this week at working three 12s in a row…egads!)

Capstone is in full swing and I am loving every second of it! This is DEFINITELY the kind of nursing I want to do when I graduate.

My preceptor is giving me a lot of independence. As soon as she feels comfortable about me learning a skill, she turns me loose. This has been both affirming and terrifying. At this point, she’s having me be completely responsible for 1 of our 3 patients (except for hanging chemo and blood products, which students are not allowed to do). That means assessments, charting, med administration, IV management, ADLs (activities of daily living), education, etc. The only thing I haven’t started doing is charting care plans and patient education because that’s a little more involved.

Being a student does have its drawbacks. I think it makes some people more nervous than it did on Med-Surg. After all, these are really sick kids. My patient who asked me if I knew what I was doing didn’t seem to like me much or have much confidence in me. Not that I blame her. She was in terrible pain and had just found out her prognosis was terminal, so I’m not sure I’d be entirely comfortable with a student nurse at that point in my life either.

My patient last Tuesday was an adorable little boy with an active imagination. This was his second relapse after two rounds of bone marrow transplants. He had just finished chemo and was in the hospital for “count recovery”.  Basically we are doing everything in our power to strengthen his immune system and get his counts back up – white blood cell count, red blood cell count, platelets, hemoglobin, hematocrit, etc. – basically everything that goes in the toilet with cancer and usually gets worse with chemo.

After his counts stabilize, they’ll do a bone marrow aspiration. If it’s clear of blasts (immature cells indicating cancer), they’ll try another transplant. If it shows that he’s still not in remission, they’re pretty much out of options.

Which brings me to the blessing and the heartbreak of peds oncology nursing. My preceptor told me that many of the patients I care for will probably die in the end. A lot of people wonder why I would want to subject myself to that kind of suffering, especially with kids. I’ve already addressed this previously, but let me just say this…

Despite the sadness, these kids are still kids and they still bring so much joy and laughter and youth to the lives of the people they touch. From a selfish perspective, my life has been enriched by knowing them. And if I can be there and give them as much life and energy as possible for as long as possible, and then hold their hands when they suffer, then I’ve been able to give a little something back for all that they’ve given me.

Plus, in the spirit of family nursing, their parents and siblings and friends and relatives need and deserve the best support we can provide. Last week I waited in the hallway with a little girl who wasn’t allowed on the unit (no one under 12 can visit because of the H1N1 scare). So we stood at the window of the schoolroom and waved at her baby brother on the other side. He was SOOOOOO happy to see his big sister.

That’s why I love my job.

Reason #1 why I love pediatric nursing?

Party hats!

One of our patients who has been on the unit forever celebrated her birthday today. So Mom and Dad decided to throw her party with us! They brought us cupcakes, party favor bags, and duh duh duh, party hats! Our patient even had a ladybug costume on! Adorable!

Reason #2 why I love pediatric nursing? These kids are not shy of reminding you when you’re doing something wrong or unnecessary. It’s hilarious…and humbling. I went in to my 10-year old patient’s room because her IV pump alarm was beeping, and because I wasn’t familiar with that particular pump it took me a few seconds to figure out the problem. The patient looked right at me and said, “Do you know how to do this?”

My adult patients never questioned me. I could speculate for hours about the reasons for the discrepancy, but most of these kids have been sick for a long time and they know the drill way better than me. For example, when I was flushing a central line today, the patient clamped and unclamped her line like a pro. She probably could have hooked everything up herself and taken way less time than me.

Reason #3 why I love pediatric nursing? Every day is a challenge and a blessing. One of my patients is going to die. She just found out that her leukemia has relapsed and the prognosis is terrible. Her bone marrow showed over 70% blasts (immature white blood cells). There are so many things to think about. So much to fear. And she is sad, which is understandable. But she’s also a 10-year old who wants to do an art project tonight.

Every day is a challenge and a blessing. And I am blessed to know that this is where I am meant to be!

I am in love with my capstone rotation.

I am in love with peds hem/onc.

This is where I belong.

More after my shift tomorrow. I have another early morning coming up!

So technically my capstone hasn’t started yet. But I have a really good feeling about this experience after meeting with my preceptor (“C”) this morning.

For one, she loves to teach. She appreciates what it’s like to be a newbie and doesn’t turn up her nose when nursing students make silly mistakes. I told her the story about taking a patient’s pulse with my thumb (big no no, seeing as your thumb has a pulse of its own) on my first day of peds, because I was so nervous.  She just laughed and told me about a new nurse who forgot to put the blood pressure cuff on the patient and couldn’t figure out why the reading was so off.  That made me feel so much better!

I mentioned earlier that there was some confusion about whether I would be in the clinic or on the inpatient unit. I WILL be inpatient, which I actually prefer as far as developing my skills (and nurturing a possible job offer if all goes well). We are going to see if I can shadow another nurse in the clinic a couple of times, just to see what it’s like. But I’m much more likely to get hired onto a unit than a clinic right out of nursing school, so making those connections is going to be critical.

C also has big plans and high expectations for me, which is a good thing! Before the end of my rotation, she wants me to be comfortable with a standard patient load (3).  We’ll technically share the assignments, but she wants me taking the lead on all three and delegating to her. During my orientation shift, we’ll be doing a lot of skills practice – accessing ports on “Chester” the training torso , playing with the IV pump, calculating meds, etc. She’s even going to let me practice blood draws and IV starts on her!

We discussed my interest in peds end of life care, and we decided to focus on developing my knowledge base in this area. She’s going to see if I can sit in on some consults with the palliative care team (with the families’ permission of course).  It was so refreshing to tell someone my goals and NOT have them look at me funny. When I explained why I wanted to do peds hospice, she said it was “beautiful.”

Which brings me to yet another reason I really like her. We get along famously so far. Our meeting this morning lasted almost three hours, although neither of us noticed.  It was so comfortable and I felt that she respected me as a person, rather than viewing me as an ignorant student. She’s still my teacher but it’s helpful to know that she thinks I have something to contribute too!

Orientation is a week from today and then I jump in headfirst the next morning. Let’s get this party started!

Pardon the pun, but this show deserves the bad humor anyway.

After frustrating encounters with HawthoRNe all summer, I was holding out hope for the third of three nursing shows this year: NBC’s Mercy.

I think my hopes have been dashed. It’s a bad sign when you actually look forward to the commercials.

Chloe (Michelle Trachtenberg), Veronica (Taylor Schilling), and Sonia (Jaime Lee Kirchner).

I will admit to (apparently) unrealistic expectations that medical dramas be somewhat realistic. But c’mon, when a supposed physician calls heparin a “blood thinner,” you have to cringe a little. For the love of a basic medical education, heparin (and warfarin, for that matter) are NOT blood thinners, they are anticoagulants. Do your research, writer’s room!

And the chest compressions Nurse Veronica did were a little pathetic. You’re not gonna do much for a coding patient when your elbows are bent and you’re 10 feet away from the gurney.

But alas, I accept the fact that medical shows will never capture real health care providers’ knowledge and abilities. It is fiction, after all.

My issue with Mercy has much more to do with the cultural stereotypes it portrays. In true form, here are a few of my biggest pet peeves about this show…

1) Yet again, the doctors come off as either a) abusive jackasses or b) incompetent newbies. Whatever happened to intelligent physicians who collaborate with nurses? I know there are still some jerks and/or idiots out there, but is it really that terrible?

2) One of the main characters (Sonia) is a social climber determined to escape from her lot in life by dating lawyers and swearing to get out of Newark. The supporting characters reinforce the stereotype of blue-collar families drinking heavily and frequenting dive bars, where there is almost always a fist fight.

3) Sonia also views nursing as “just a job,” which is the first stop on the road to total burnout. And disheartening for those of us who are just starting out.

3) The new nurse (Chloe) shows up in cartoon scrubs and seems completely clueless.  She can’t figure out that her patient has an air embolus, even when he’s hooked up to a pulse oximeter that shows his oxygen levels at 79%!!! Instead of bagging him, she screams for help. Even worse, she just got her Master’s degree and was top of her class, so her clinical stumbles paint higher education for nurses in a very negative light.

4) The experienced nurses only minimally tolerate Chloe, being completely inhospitable when she first shows up and declaring after a few days that “this is the first time [we] didn’t want to kill you”. I’ll be posting later this semester about the whole concept of “nurses eating their young,” but this show reinforces that dangerous idea.

5) The main character (Veronica) is completely messed up and recently returned from Iraq. Her story reminds me so much of Dr. Hunt from Grey’s Anatomy, it’s scary. How about a little originality when you sketch your characters?

Yes, I had my issues with HawthoRNe but I’ll take the clever writing and authentic acting of Jada Pinkett Smith any day over this drivel.

I’m giving it one more week to even attempt redemption, but at this point survey says “Two thumbs down”.

I’m not the only one who feels this way either.