Day to day.

I'm procrastinating. In seven days, I'll take the CCRN exam, and test my experience...or should I say, knowledge, about critical care nursing. I feel about 73% ready. I'm shooting for 80%. All I need is 75%.

It's been an interesting experience, studying for this test. I've gone through a few stages. The first, was, like this one, a reluctant stage. I studied in clusters, not really paying attention to any particular area, just looking over things. I took test questions, but found myself stumped - not because the questions were difficult, but because I simply hadn't been exposed to quite a bit of the information. Car accident with left shoulder pain? Hm, sounded like an MI...nope. Clear as crystal: spleen rupture. Never came across that in my little world of MICU. Which vessel was occluded when said leads were changed with ST elevation? Ha! My extent of cardiac nursing goes from looking to enzyme levels and handing the ECG to the resident. Not that we don't deal with these kind of things in our unit, it's just not a regular occurence that I'm expected to know the specific effects of a RCA occlusion. Needless to say, I don't think this stage was my best.

Second stage: reading. A friend loaned me a book, and I read the entire thing. The questions made sense! Of course, I understand now the intriciacies of Guillian Bare syndrom and Acute Lymphocytic Anemia -- the questions aren't very complex, they simply require an ability to recognize familiar facts. This was the most beneficial stage, clinically speaking. I started to recognize things that I hadn't before -- a patient with severe mitral regurge became short of breath when hypertensive -- of course, keeping his blood pressure low helped his breathing! A PE here, a case of liver failure gone bad there...things became clear to me -- from textbook to real life.

Third stage: one week from the test, and I'm just plain unmotivated. There are still things I need to commit to memory -- those walls of MI throw me every time. And balloon pump wave forms, and pacer codes are still vague. Cranial nerves? The worst. I need to just sit down and memorize, but I'm at a loss for motivation.

Either way it goes -- whether I pass or fail -- it has helped me clinically. This wasn't what I expected. When I studied for the NCLEX, everything I knew was book knowledge. Now, it's the opposite. Transforming experience into test questions and answers is difficult...hopefully my thinking cap works next Tuesday.

Two Years.

Well, I've done it. Reached, no, survived another nursing anniversary. Hard to believe I've been at this thing for two whole years. Twenty-four months. Seven hundred and thirty days, give or take a few. It feels longer.

Family members still ask me how old I am. One, a patient, chronically on the ventilator, wrote a note to her husband that said, "That white girl looks like she's sixteen," while I was starting an IV in her tiny arm. It always surprises me to hear myself say, "No, I'm not sixteen, but thanks. I'm twenty five, and I'm going on my third year of nursing."

Just the other day, one of them was surprised, saying she thought I had been a nurse for much longer. That I had a lot of wisdom in my practice, from what she could tell.

Generally, things have slowed for me. Not many cases throw me for a loop anymore, leaving me feeling like I've just been freshly mugged at the end of the day. Shifts are usually filled with the routine of sepsis, neuro emergencies and the occasional person in DT's. I'm starting to think that I'm ready for the next thing.

Today, I looked for jobs in my hometown -- Buffalo. There were only two or three -- in the whole city -- that applied to me, ICU jobs, most of them night shifts. It occurred to me, for the first time, that I might try something new? ER? Psych nursing? Home health care? Daunting, but true, the opportunities are scarily endless. Hell, maybe I'll learn how to deliver babies and realize I've been missing my calling this whole time.

Doubtful, but something to think about. We'll see. For now, I'll keep plugging along with my renal failure-hypertension-rare overdose-ARDS-GI bleed folks. I'm sure they'll keep me on my toes.

48 Years.

"48 years," he said. "We've been married for 48 years." His wife, in the bed, managed a weak smile from under the stiff plastic mask pumping 100% oxygen into her lungs. With the hat on his head declaring service to the U.S. military, and a Bible in his hand, he sat at his wife's bedside - close enough to see her and yet far enough to feel the wall of illness separating them - for almost my entire twelve hour shift.

The day was busy. We floated in and out of the room to and from CT scans and MRIs, each time we left, he made sure to tell her he loved her, and leave a kiss on her forehead. As her results came back, showing a small hemorrhage in her brain, and as the hours past, and I checked her declining neurological status, he sat, calmly talking to family, hardly batting an eyelid at the bad news.

He doesn't understand, I thought. He doesn't realize that his precious wife, who he painstakingly cares for at home, might not see tomorrow.

I approached the resident, telling her of the patient's declining mental status, and high risk for respiratory failure and need for mechanical ventilation. "You need to talk to the husband, give him a heads up," I say, all the while knowing that the words from her would undoubtedly come out wrong; twisted by medical jargon, a foreign upbringing, and lack of experience. But I was busy, I needed to catch up on things from my other patient, she was a second-year, she could handle it.

But, as I suspected, when I returned to him, I could see the confusion in his eyes. "What is this doctor talking about? Intubation? A ventilator? Isn't that mask breathing for her?" Things hadn't gone well. I sat down, and for a good while, explained to him and his son, what the blood in her brain was doing, how, if the bleed grew, it would cramp her brain, drowning it, keeping oxygen out, making it harder and harder for her to stay awake. The ventilator might become necessary to keep her alive, if that happened, and her brain stopped working as well because of the stroke.

Some people stop there. Why continue? You've gone above and beyond to give them fair warning -- why tell them that even thought the venitaltor might save her now, it might prolong suffering that she won't recover from? Her brain might get better, and then we'd all be thankful for the tube, the breathing machine, right? But what if it got worse, and she didn't wake up, and we, as we do so often, find ourselves with little else to do but pull the plug? Would she want to live on life support, in a nursing home for her remaining years, with little to no brain function? Or would it be better to just leave things as they are now, to let her pass quietly in her sleep?

But I had to, and I did. He loved her so much, and the last thing I wanted, was for him to visit tomorrow morening and find her garishly altered, with a tube in her mouth and a machine breathing her -- without having at least a warning. I didn't want him to miss his last conversation with her -- I wanted him to know, and see, just how sick she was.

He and his son talked it over. They said, if she needed the tube and the machine, that they'd want to be called first -- no matter the hour. Hopefully she wouldn't need it, they said. I agreed. It was a wise decision, a good conversation. They understood. He understood. When I left the room, I was glad I had taken the time.

Later, walking past, I caught a glimpse of him. Hat off, crouched in the chair by her side. His eyes looked tiredly at her, I could see his fear. For the first time, he realized her life wasn't as secure as he thought. While I never doubted my decision to inform him of how critical things really were for her, my thoughts haven't left him these past few days. I can only imagine what he feared -- losing her, meant losing his wife, his companion, his friend -- 48 years worth.

My thoughts are to my own life, my own relationships. What decision will I make when it's my time? Will I push hard, asking for everything, knowing that I'm only prolonging the inevitable? But, if I make it to 48 years, will you be able to blame me? 48 years is a long time to love someone.

Should I stay or should I go?

Today, life is demanding answers from me. One, really, in many different areas: do I stay or go? Today, it was in reference to my job.

I just returned home after a meeting with the Shared Governance Research Council, a nursing organization within the Nursing Department of most hospitals, of which I'm a member. Today, instead of just listening to the drivel of information, I presented a proposal for a research study I'd like to and have been working to carry out with two Bioethicists whom I work with.

The meeting went well, and we received approval to move to the next step, but the thing I carried with me was just how much time I'd have to commit. This study would be merely the beginning of an entire research path, a laundry list of studies that would, undoubtedly enhance my resume and experience far beyond my years or education, but will also take...a lot of time.

With tentative goals to move on to another place and type of nursing around this time next year, the meeting, which should have come as good news, turned out a bit unnerving.

I feel like a major review of my priorities is in order. What is most important to me, what will make me stay, what do I really hope to get from this job and place and experience?

But while thinking on it, I started to wonder what makes nurses, in general, stay in one place. Nursing retention rates are extremely low, and although improving in some areas, continue to persistently disappoint. A recent study (perhaps I'll site later, but a tad spent to find it just now) found that nurses who are involved in extracurricular hospital-wide activities, given autonomy and leadership in projects are more apt to stay longer than those who aren't.

While this is true for me -- as far as the unit goes, I've essentially capped my learning there, what's holding me is financial and project-commitments -- it's still difficult for me to pin myself down for sure. Starting a Master's is even a daunting task, simply because it'd tie my here for three years at minimum -- a period of time away from family, which I'm not too thrilled about.

Job, relationships, life in general, it just seems like I have to start figuring out where I want to settle, to stay...to invest. Part of me thinks I'm too young, but with a birthday around the corner, and a two-year-anniversary of nursing a few weeks after that, I'm starting to think I'm getting close to the place where I need to decide.

Nice RN Pick, Obama!

I knew I voted for Obama for a reason.

Although it mildly annoyed me that he mentioned nurse in the same category as janitor and garbage man (two admirable, but unskilled job titles) in two of his debates, I figured he'd be pro-RN by the ANA's endorsement of him, and his campaign's ability to think out of the box (all RN's have that quality).

But today, I found this article confirming Obama's love for nurses.

It's an exciting article proclaiming Obama's selection of Dr. Mary Wakefield, PhD, RN, FAAN to director of the Health Resources and Services Administration.

Finally, a position filled with a worthy candidate, in a job I'd like to have one day.
If only I could get a hold of her resume so I could figure out how she got there...

Needless to say, will be eagerly watching her work in the HRSA, specifically to see if she has the same view as I do, that universal healthcare in the US will never work without first establishing a stronger network of medical homes, in the form of free-low-income clinics. What good is universal healthcare if no MD will accept it?

We'll see. Maybe I could fanangle my way into her office for an interview.

RN:MD Money Ratio.

Yesterday at work, I had a conversation with a resident that's stuck in my thoughts today.

I was returning to the unit from taking one of my patients to a test, and I jokingly mentioned to him that, as evidenced by my other patient's awkward position in bed, my co-workers had neglected to check in on her for me while I was away, as they had promised. We laughed, and he said, "If only you could clone yourself," to which I replied, "Right. If that were the case, I'd expect to get paid double."

Funny idea. He laughed, I laughed, and then he said, "Hey, don't say that. You already do get paid double what I get paid!"

"True," I said. "For now."

It's great that I get paid double what this resident gets paid. I think I deserve it -- yeah, he has 24-hour call every five days, and has to work 7 days a week, but I think I work harder. I'm responsible for the lives of two patients, and for 12 hours straight, I actually physically carry out the myriad of tests, procedures, monitoring and general upkeep that is required to get them through their ailments.

That's not what bothered me about the conversation. What bothers me, is that in five years, when this resident is out of training, his statement won't be true. In fact, he'll be doing LESS work, for more money. While I, the RN, if I stay in my current position, will be making around the same amount.

Sure, the longer you stay in nursing, the more you make. With my Union, I get a good raise every year, so by my 30 year mark, I'll be making six figures.

But that's thirty years from now.

Immediately after I uttered the words, "For now," I stopped what I was doing and thought for a second. Thirty years is way too long to wait to make a six-figure salary. And, if I believe that I'm an expert, and that nursing is a field with endless options for advancement, there's no way I'm waiting that long.

It was good to realize, that, although it might not seem so to the bystander, nurses have every opportunity to make just as much as MDs do (although, for the record, I do believe the incomes of RNs and MDs should be swapped...but that's a post for another day).

The options are endless, and often free for the taking. Get your master's, get into administration, specialize in a field and become a sought-after consultant. All of it starts with the two letters: RN.

For those of you reading who don't have those letters behind your name just yet...here's one of many programs -- it's a scholarship program from the Robert Wood Johnson Foundation and the AACN -- that hand out money to people ready to join the RN trend: http://newcareersinnursing.org/

6 Months?

August 31, really? My last post?

It's hard to believe that 6 months has passed since I last looked at this site. I'm not surprised, just shocked at the visible passage of time. Apparently, I should just admit that I'm a horrible blogger. Done.

Life, for me, has continued. As a nurse, I feel increasingly confident. I've passed my year mark and am nearing my second anniversary. I sought out an advanced certification (ACLS), and am working on taking the CCRN exam ( a test that certifies my as a critical care RN). I've joined the AACN, and am running a monthly journal club out of my unit with a goal of publishing some research in the next year. I'm enjoying my work, my co-workers and looking to the future with good feelings.

For my patients, things have stayed the normal course. A repeat-patient that I took care of over the course of the past year and half, a pretty little lady with a bad pair of lungs, passed shortly after Christmas. It was sad to see her sisters, who I had gotten to know during my care of her, so distraught at the eventual realization that she just wouldn't pull through this infection, this time. I miss them, even though I know that death was the only, better option for her painful struggle.

I've had a few significant sickies...a GI bleeder I fought for who got to surgery too late, an overweight, but super-sweet woman who fought (and beat) sepsis, and a pair of ARDS patients whose families both decided to withdraw care, during the same shift, within 15 minutes of each other.

These are the people who make it through the cluttered memory of my 12 hour days, and the exhaustion I feel afterwards. Families and patients who, for one reason or another, keep me running, and yet make me smile days later. The ones who I remember, and mourn with, and yet, encourage at the same time.

All in all, it's good to be a nurse right now. I haven't spent a stray thought on the economy, I've grown in my role on the unit, and I'm thrilled to be spending extra time giving back to my co-workers, and my patients.

Will try to stay in touch more frequently...:)