Sunday, October 31, 2010

First Night as LPN

One thought sums up my first night as an LPN.

Wow... That's a ton of paperwork. A TON.

I never realized exactly how much. There is at least three ways we are required to double (I guess, technically, triple) check our MARs. Handwritten orders which I can't read. Double-checked against MARs that may or may not accurately describe what is on said order. I have to make up info sheets for my CNAs with information pulled from the chart and kardex.

I have to handwrite notes on each and every patient every 3 hours; even overnight. I have to document medication administration and teaching. I participate in planning a my patients' interdisciplinary careplan with other people (ST, OT, and PT).

It's quite a bit of work; more than I initially thought. However, I do have a thought to all current nursing assistants: nurses really aren't just lazy; the paperwork really does take all friggin' night to get done!

I also got to do my first official sterile procedure: a straight catherization of a female patient with over 700mL left in her bladder according to the bladderscan machine. I missed. I didn't feel so bad that I missed because even the other nurse that was orienting me couldn't get it in. We had to get a more seasoned staff nurse to insert it. The realization is pretty obvious to me now that all that anatomy and physiology I learned doesn't mean jack; gravity is pretty cruel because later in life, anatomically speaking, things just ain't where they supposed to be. A little tip I learned from the "pro" was that the urethra on a female blanches white when hit with the betadine swab.

All in all though it was a good night. I got to do some basic skills, get some stuff signed off as competent, and I'm going back tonight for round two.

Saturday, October 30, 2010

Things I'm Going To Do When I'm Done

I've decided to compile a list of things I'm going to do after I'm done with my ADN and after NCLEX boards are complete. These thoughts are what is helping me through this life-consuming program:
  1. Sleep 8 hours a night.
  2. Eat three meals a day (healthier too; McDonald's has been a staple food this year.)
  3. Take vacations every year.
  4. Buy clothes from a place other than Wal-Mart.
  5. Have at least one day with no work and no school.
  6. I'm going to find and participate in some sort of hobby.
  7. Attend everyone's birthday party; I've missed more than my fair share these last two years.
  8. Attend family functions. See #7.
  9. I'm buying a Playstation 3 and/or X-Box 360. This is non-negotiable.
  10. I will watch television, with family members, while drinking coffee. This is one thing I miss incredibly, even though it seems so simple.

Some of these things I might even be able to accomplish when I begin full-time work as an LPN. However, since I do work for a pretty big corporation in the sales department, the LPN pay increase is substantial, but it's not like I'm going from $8 to $22; it's more like I'm going from about $15 (plus commission) to $22. I'm under no assumptions I'm going to get rich... just a little more comfortable.

This year has been tough so far; makes no mistake, you will certainly have nearly your entire life consumed by nursing school (don't get discouraged pre-nursing students). I got a bunch of buddies with Bachelor's degress in crap like 'communication', 'leadership', and 'liberal arts'. I don't recall them saying school consumed their life! In fact, I remember hearing more stories of drunken escapades than of anything educational. Of course, most of them are still couch-surfin' at Mom and Dad's also...

OH! And more great news. I no longer have to do "care plans". They feel we are proficient enough to create 'concept maps' without any rationales. SCORE! Workload decreased by about 60%. That's great news. I'm going to post a really great hypothyroidism concept map I did for feedback.

BSN?

I got to sit through a lecture from a professor, and the head of my nursing program, about doing a BSN program at the local university.

My thoughts? Too soon... way too soon! Talking to me about a BSN right now is like making fun of your friend who got killed doing something retarded... it's funny, but not for at least a year after it happened. Same general idea with this BSN degree; it might happen, just not for at least another year.

Although it peaks my interest... imagine... me... with a Bachelor's degree. Even better, another two years and I get a Master's. The local university has a family nurse practitioner track. That would be sweet. Real sweet.

For now though, I'm just thinking about getting this ADN done and the NCLEX-RN. But it doesn't hurt to think what that actually makes possible. Me... as a primary care practitioner. It boggles my mind! The more I think about it, the more I think I made a really good career choice!

Friday, October 29, 2010

Networking

I just happened across a member of the organization that gave me a $1000 scholarship for school. And guess what? He also has pull at the nursing home I'd like to work at per diem. Says he'd like me on board. Funny how things work out! Moving from a corporate atmosphere to a healthcare one, I'm seeing quite a few similarities. Like this for example: It's not what you know; it's who you know.

Only problem with nursing homes, in my opinion, is, well, that they are homes. Essentially, these people live there and you take care of them. Not really my cup of tea, however, I like those types of facilities more than I thought I would. Not to mention they pay bank compared to hospitals; however, since your patients are stable, you typically have more patients than acute or subacute care. Quite a bit more! However, per diem, you can make a nice bit of change on the side and that's always a plus.

My real love is acute care. I like taking a really, for lack of a better word, jacked up person and make them better. I like seeing that whole transformation; I loved my ED rotation!

Skills Check Passed

Another gripe I forgot to mention about the other day's bullshit skills check was that the room was double-booked and I got to do my skills check in a room with an entire class of overweight, loud, sweaty, redneckish EMS students migrating in.

Today, I redid the procedure in front of my instructor, who I might add agrees that I have reason to be pissed. Anyhow, she apologized for the crappy situation and while it certainly doesn't add the two points back to my grade, it's at least nice to know that my frustration was recognized and that I am not being unreasonable.

It is what it is. I'll get over it. I've got grade points to spare... for now.

In other news, I will be officially starting my orientation as LPN tomorrow night at the subacute rehabilitation facility. I feel pretty lucky getting a job that is essentially like working on a med-surg floor. I'm so excited, I decided to buy a new sport watch from eBay and a pair of scrubs from Uniform Advantage. When you are cheap as hell like me, you'll enjoy these websites for a variety of things.

Next semester, I think I'll use any leftover scholarship/Pell grant money to get a decent stethoscope. I'm thinking either Cardiology III or Master Cardiology. Can't decide which is better; I'll probably just check the forums at allnurses.com for the general consensus. If you are a nursing student reading this or a pre-nursing student, a big piece of advice is to get a good stethoscope. The difference is absolutely amazing. Superior equipment is no substitute for inferior skill, however, the difference is more than noticeable. Sometimes those damn crackles (damn, I mean rales, my nursing instructor would kill me) are just not easy to hear!

Until next time!

Wednesday, October 27, 2010

PISSED!

So I failed my friggin' skills check. And it was bullshit.

First, let's start off with what I did right. I interpreted an ABG based on a case study. I selected the probable cause of my tracheostomy patient's respiratory acidosis as an airway obstruction and selected suctioning as my intervention. Passed.

After selecting this intervention, I gathered the required suctioning supplies, established a sterile field, and suctioned the patient with no issues. Passed.

After suctioning, another skill I had to demonstrate was tracheostomy care. Basically just cleaning the neck, cleaning the inner cannula, replacing the gauze, and replacing the ties. I set up and performed tracheostomy care perfectly. Passed.

So where did I go wrong? When I set up my drape, I accidentally covered a pair of scissors. I told the proctor, a new instructor that's approximately my age (28), that I broke sterility and needed the scissors so I needed to restart. I lifted the drape, moved the scissors, and redid everything. Perfectly. So what happened?

The instructor stated that I moved the scissors with my sterile hand, broke sterility, and continued anyway. Really?

I mean when I said I had to restart, I feel that it was implied that I was regloving. I mean, I knew that I touched these damn scissors, but I kinda thought I was like on a "time-out" if you know what I mean. I didn't know she expected me to completely reglove. In the past, calling your sterility break, moving things around the table, and then restarting has been acceptable. I think it's just petty. I mean I did the procedure perfectly.

So what does this mean? Not too much fortunately, but I'm still mad. I need to redo the sterile setup of tracheostomy care; that's all. I also get minus two points from my lab grade, which I'm not too concerned about because I have points to spare. I've gotten an 84% on nearly every test except for one.

I feel like it was just petty. A few students have gone so far as to think that maybe they are trying to weed people out so that the school gets a higher NCLEX-RN pass rate. I've even suggested that the particular instructor who got me on such a stupid technicality needs to get laid; just not by me.

Anyhow, sorry for vent/rant. It's just that when you put in hundreds of hours in a class (since September) you get a little pissy when you think someone takes points off a grade you've worked your ass off to get.

P.S. I'll never be a nursing instructor! I don't care if you are an instructor, or you are a student, why in the hell would you ever want to come back to this nightmare!

Wednesday, October 20, 2010

A Big Step

Well, I was officially hired as an LPN at the facility I worked at as a CNA. The hourly amount was $22 an hour plus shift differential, which means I'll be making $24.50.

Needless to say, this is a pretty big improvement over what the telecommunications company was paying me; I was left with little choice but to resign today.

I've been here for nine years. It's taken me nearly three years to complete the first part of my nursing education. It's still hard to leave my co-workers, who in time, became really good friends. There are, however, things I won't miss by changing careers:
  1. No dress clothes!
  2. No commissions!
  3. No quotas!

These are three big things I won't miss! It's still a very scary step for me, and was really hard to muster up enough backbone to actually send that resigaation letter.

Sunday, October 17, 2010

Mock Code

After getting my LPN license, I start to drool at some of the things the RNs can do, and after having some practice, really can't wait.

I had a great ED experience with plenty of skills practice, but I got to do a mock code the other day and it was awesome. I really want to get ACLS certification (Advanced Cardiac Life Support). It would be really cool to "run" a code, which is essentially the person who watches the monitor and gives orders.

Cool thing is, in a situation like this, it's usually a nurse that runs the show and not the doc. Codes don't wait for doctors to be on the unit, and it's up to the RNs to respond. I love the idea of running a code; reading the EKG monitor, interpreting the rhythms, and ordering particular drugs to combat particular rhythms, or ordering a shock.

I never realized so much went into a code. For example, you always see people on TV getting hit with the defibrillator paddles after they are flatlined on the monitor... this is totally wrong, as you can't shock no rhythm. You'd probably give epinephrine and see if you could induce ventricular fibrillation, or v-fib, or ventricular tachycardia, also known as v-tach. These are shockable rhythms.

We ran a mock code at school. It was ugly; really ugly. Glad it was ugly on the dummy and not on a real patient.

New Job Horizons

Ok, so I probably found some pretty decent LPN jobs.

The rehabilitation hospital I worked at as a CNA hired me and is putting me on nursing orientation tonight! Unfortunately, I still do not have an LPN name badge and no one has, as of yet, even discussed pay with me. Due to the slightly anonymous nature of my blog, I will report back what I was offered as a new grad.

I also have discovered a flex position at a local nursing home that reportedly pays about $28/hr for its flex LPNs. I filled out an application fairly quickly after hearing that, believe me. The good news is my friend from high school runs a community clinic where I live as an RN-BSN, and he is friends with the assistant director of nursing. Hopefully I can use him as a reference and have her look for me. That would be absolutely awesome to get a job making that kind of dough!

According to internet sources, my state's average hourly LPN rate is about $23/hr. So, they pay above average. However, it's per diem, so there's no guarantee of hours and there are no benefits. So it's a good bit above the average, but not unheard of since they aren't doing any sort of hour guarantee or benefits. But for that kind of money... I can live with those stipulations (especially if it's just a side gig)!

On a more frightening note, I'm absolutely terrified to get my liver/immune system test back. I feel pretty bad about it. I'm not going to obsess like I did last year though... it is what it is.

Home life is pretty craptastic lately as well. What was supposed to be a great time in life, getting employment as a nurse, has turned into a major resentment for my wife. Since she no longer wants to be with me (and trust me, the feeling is mutual) she views this new career with a whole bunch of resentment.

I would really like to go out and have a beer or two with friends, but my schedule is so insanely crazy I have difficulty squeezing in time for meals, even though I'm somehow getting fatter. Life pretty much just sucks... it seems like the only saving grace is that at least I'm doing pretty good career-wise and pretty good in school (until that damn liver test comes back).

Thursday, October 14, 2010

It's Official!

Apparently tired of watching YouTube and apparently out of coffee, my state BON has reviewed my documentation and officially awarded me an active nursing license number! It's official... from here on out and forever-more (at least until this summer) I am an LPN for life!

Tonight's test is pretty compehrensive. I've got a test on the liver and immunologic diseases. Unfortunately, my teacher, who is pretty awesome, allowed a student teacher, a girl going for her MSN as a nurse educator, to teach the liver section. In my opinion, this was way too complicated a section for her to be teaching. All of the different hepatotoxic drugs, the dietary requirements, and the pathological differences between diseases of the liver, such as Laennac's cirrosis, as opposed to acute liver failure (ALF), was I think a bit over her head. She had difficulty pronouncing basic physiological terms, such as the renin-angiotensin system, which I'm very familiar with due to having a ton of patients on ACE inhibitors. Not to mention her tone was Ben-Stein-like in its monotonicity.

In personal news, my marriage is pretty much officially over. I don't really know how it came down to this, but my constant absence from home due to insane work and school schedules has pretty much made my wife resent me and she currently has an inappropriate relationship with another man. I continue to live at home dealing with this while attending nursing school and it's making my stress level go through the roof. I would have thought she could have waited for my school to end and then everything would have been better than it ever was, however, I guess she just could not cope. I expect to be moving out of our home either in January between semesters, or in June after the conclusion of my RN year.

I understand her needing someone home to help with my son and her kids, however, I feel that my schooling was supposed to be hard for both of us. It's hard for me due to constant deadlines and boatloads of work; it is hard for her because the running of the house, school functions, bill paying, her part-time job as nurse tech, and other things fell solely on her to handle independently. However, I feel that I am the only one that kept up my end of the bargain; I did, so far, what I set out to do. I feel like she got overwhelmed and sought comfort and help in someone else. And I'll just go on the record and say I feel that what I have been going through with this crazy ass work and school schedule was way harder than running a household.

Anyhow, I truly believe I'll be a better person for all of this. I will have a career that can support my family, namely my son and ailing mother, and as a plus I will get to help people on a daily basis. I'll wager to say that this whole experience has been worth it; it showed me how fragile my marriage really was and it showed me that the person I want to be with needs to be more independent and self-sufficient. I think her choice to seek outside "companionship" is just a reflection of her co-dependence.

Oh well, it is was it is, but I worked very hard to get here and with my RN licensure on the horizon, I refuse to take my eyes off the prize now.

Wednesday, October 13, 2010

ED Madness

Well, I'm still waiting for those morons at the BON to give me my license number... I suppose they'll get to it after they've drank enough coffee and watched enough funny animal YouTube videos.

I'm doing very well in class. First two tests I've scored an 84% on. Got a 96% on my final graded careplan! Now I can just do concept maps... thank God! I'm thankful for the good grades, however, unlike last year, I absolutely refuse to be obsessed with my grades. It is what it is at this point, but I think I'm doing pretty good.

Last night was my first night in the ED. I must say I think I've fallen in love with that type of nursing. It was fast, we were busy, and my eight hours flew by. My preceptor and myself must have seen about 25 patients.

I'm loving the fast pace, the close collaboration with medical staff, and the variety of problems: from the slight illness to the traumatic injury.

Saturday, October 2, 2010

Stress Increase Before Stress Decrease

Well, I turned in my letter of explanation for my ultracriminal underage drinking charge nine years ago. Hopefully, I'll have an active license number sometime this century!

I already have a job waiting for me at the rehab hospital where I am a tech. I can't wait to get in tonight and check my inbox for my offer letter! This is great news, because I'll be making some pretty nice change part-time as a flex pool nurse there.

I'm kind of upset though because I still gotta work this weekend as a tech, and my major paper this semester is due on Monday. Basically, I don't see any time to do this paper between now and Monday because I'm literally working all weekend without any sleep.

I was hoping that by passing the NCLEX-PN before having to work a sa tech I'd get myself outta work this weekend... but I should have known they don't process that job change that quick.

Now I gotta work 10a-8p at one job, then 10p-7a at another, sleep for a few hours, work from 11a-5pm, then sleep for a few hours, than work 10p-7a, then sleep for a few hours, then my assignment is due Monday at 2:30pm!

Anyhow, hopefully I'll have enough down time at both jobs before it's due on Monday. I'm in major need of a miracle!